@Article{info:doi/10.2196/69242,
author="Brown, Marie Jacqueline
and Rita, Nicholas
and Franco-Arellano, Beatriz
and LeSage, Ann
and Arcand, Joanne",
title="Evaluation of a Curriculum-Based Nutrition Education Intervention Protocol in Elementary Schools: Nonrandomized Feasibility Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="16",
volume="9",
pages="e69242",
keywords="nutrition education",
keywords="serious games",
keywords="children",
keywords="food literacy",
keywords="school nutrition intervention",
keywords="feasibility",
abstract="Background: Improving children's food literacy through school-based interventions can support developing healthy eating habits. However, teachers lack appropriate resources, time, and training to provide nutrition education in schools. Serious games, which are games designed for a purpose other than entertainment, have been demonstrated to improve children's food literacy and dietary intake and can address the barriers teachers face in providing nutrition education. Foodbot Factory (Arcand Lab) is a nutrition education intervention that is aligned with curricula and uses a serious game to provide nutrition education to students. Further evidence is needed to understand how serious games, including Foodbot Factory, can be researched in schools to support nutrition education. Objective: The objective of this study was to evaluate the feasibility of a research study protocol that implements the curriculum-based nutrition education intervention Foodbot Factory into a real-world classroom setting. The evaluation of the protocol included study processes, resources, and management feasibility outcomes, as well as a preliminary assessment of scientific outcomes relevant to the intervention. Methods: A nonrandomized study determined the feasibility of intervention implementation. Grade 4 and 4/5 classrooms were assigned to have nutrition education lessons for 5 days with either the Foodbot Factory or a control intervention. Outcomes were assessed in 4 feasibility domains of study processes (eg, recruitment and attrition rates), resources (eg, time taken to deliver the intervention), and management (eg, challenges with intervention delivery), and a preliminary assessment of scientific outcomes pertaining to the acceptability and impacts of the interventions. These outcomes were captured in semistructured field notes completed by study staff and a Nutrition Attitudes and Knowledge questionnaire and acceptability questionnaire completed by participants. Data were analyzed descriptively and using a paired t test to assess within-group changes in nutrition knowledge. Results: In total, 4 classrooms participated in the feasibility study, with varying recruitment rates for schools (3/20, 15\%), classrooms (4/4, 100\%), parents (54/102, 53\%), and children (49/54, 91\%). The time required to implement the research protocol, including data collection and lesson plans, was sufficient and management of the intervention implementation was overall successful. Some challenges were experienced with classroom management during data collection, specifically with electronic data collection. After the intervention, participants reported a positive affective experience (26/41, 63\%) and learning something new about healthy eating (31/41, 76\%). Participants in both study groups improved their nutrition knowledge, but the changes were not statistically significant. The Foodbot Factory group had a statistically significant improvement in their knowledge of vegetables and fruit (P=.04) and protein foods (P=.03). Conclusions: These findings indicate that the study protocol is feasible to implement and evaluate Foodbot Factory in a representative sample with select modifications to improve recruitment and data collection procedures. ",
doi="10.2196/69242",
url="https://formative.jmir.org/2025/1/e69242"
}


@Article{info:doi/10.2196/66970,
author="Berm{\'u}dez-Mill{\'a}n, Angela
and P{\'e}rez-Escamilla, Rafael
and Segura-P{\'e}rez, Sofia
and Grady, James
and Feinn VI, S. Richard
and Agresta, Hanako
and Kim, Dean
and Wagner, Ann Julie",
title="The Monthly Cycling of Food Insecurity in Latinas at Risk for Diabetes: Methods, Retention, and Sample Characteristics for a Microlongitudinal Design",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="28",
volume="9",
pages="e66970",
keywords="food insecurity",
keywords="monthly cycling",
keywords="type 2 diabetes risk",
keywords="quantitative methods",
keywords="Latinas",
keywords="endocrinology",
keywords="nutrition",
keywords="nutrition assistance",
keywords="micro-longitudinal design",
abstract="Background: Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We conducted a microlongitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors. Objective: This study aimed to determine the quantitative methodology, recruitment and retention strategies, predictors of retention across time, and baseline sample demographics. Methods: Participants were adult Latinas living in Hartford, Connecticut who were recruited through a community agency, invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI using the 2-item Hunger Vital Sign Screener, and had elevated risk factors for T2D using the American Diabetes Association risk factor test. Using a microlongitudinal design, we collected data twice per month for 3 months (week 2, which is a period of food budget adequacy; and week 4, which is a period of food budget inadequacy) to determine if the monthly cycling of FI was associated with near-term diabetes risk (fasting glucose, fructosamine, and glycosylated albumin) and long-term risk (BMI, waist circumference, and glycated hemoglobin) markers. We determined whether household food inventory, psychological distress, and binge eating mediated associations. We examined Health Action Process Approach model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we used repeated measures general linear mixed models. To assess the role of mediators, we performed a causal pathway analysis. Results: Participant enrollment was from April 1, 2021 to February 21, 2023. A total of 87 participants completed 420 assessments or a mean of 4.83 (SD 2.02) assessments. About half (47/87, 54\%) of the sample self-identified as Puerto Rican, mean age was 35.1 (SD 5.8) years, with 17.1 (SD 11.6) years in the mainland United States. Just under half (41/87, 47.1\%) spoke Spanish only, 69\% (60/87) had no formal schooling, and 31\% (27/87) had less than eighth grade education. Modal household size was 4 including 2 children; 44.8\% (39/87) were not living with a partner. About half (47/87, 54\%) were unemployed, 63.2\% (55/87) reported a monthly income <US \$1000, and 63.2\% (55/87) used food pantries. In total, 61 participants (70.1\%) completed all 6 assessments. On Pearson correlation analysis, having internet at home and having a tablet at home were associated with a higher number of completed assessments. Conclusions: This study demonstrated how FI cycles over the month and whether and to what degree the cycling itself is related to the risk for T2D development, as well as the evidence for some putative mechanisms of this association that can serve as future intervention targets including SNAP disbursement schedules. ",
doi="10.2196/66970",
url="https://formative.jmir.org/2025/1/e66970"
}


@Article{info:doi/10.2196/58124,
author="Kavanagh, E. Meaghan
and Chiavaroli, Laura
and Quibrantar, M. Selina
and Viscardi, Gabrielle
and Ramboanga, Kimberly
and Amlin, Natalie
and Paquette, Melanie
and Sahye-Pudaruth, Sandhya
and Patel, Darshna
and Grant, M. Shannan
and Glenn, J. Andrea
and Ayoub-Charette, Sabrina
and Zurbau, Andreea
and Josse, G. Robert
and Malik, S. Vasanti
and Kendall, C. Cyril W.
and Jenkins, A. David J.
and Sievenpiper, L. John",
title="Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="28",
volume="9",
pages="e58124",
keywords="diet",
keywords="apps",
keywords="dietary app",
keywords="Portfolio Diet",
keywords="dietary portfolio",
keywords="cholesterol reduction",
keywords="cardiovascular disease",
keywords="eHealth",
keywords="usability",
keywords="acceptability",
abstract="Background: The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory. Objective: We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks. Methods: Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12. Results: In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53\%) and 13.7 (SD 5.8; 13.7/25, 55\%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5\%) and 0.19 (SD 4.4; 0.19/25, 0.8\%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained. Conclusions: Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management. Trial Registration: ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466 ",
doi="10.2196/58124",
url="https://cardio.jmir.org/2025/1/e58124"
}


@Article{info:doi/10.2196/60092,
author="Wang, Naibo
and Wang, Chen
and Zhang, Puhong
and Li, Yinghua
and He, J. Feng
and Li, Li
and Li, Yuan
and Luo, Rong
and Wan, Dezhi
and Xu, Lewei
and Deng, Lifang
and Wu, Lei",
title="Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="27",
volume="27",
pages="e60092",
keywords="school-based health education",
keywords="EduSaltS",
keywords="mobile health",
keywords="salt reduction",
keywords="cluster randomized trial",
abstract="Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)-- and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention's effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96\%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02\%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48\%) children and 47 (8.97\%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren's salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were --0.24 g/day (95\% CI --0.82 to 0.33), --0.68 mm Hg (95\% CI --2.32 to 0.95), and --1.37 mm Hg (95\% CI --2.79 to 0.06), respectively. For adults, the intervention group's salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were --1.06 g/day (95\% CI --1.81 to --0.30), --2.26 mm Hg (95\% CI --4.26 to --0.26), and --2.33 mm Hg (95\% CI --3.84 to --0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 ",
doi="10.2196/60092",
url="https://www.jmir.org/2025/1/e60092",
url="http://www.ncbi.nlm.nih.gov/pubmed/40017342"
}


@Article{info:doi/10.2196/51271,
author="De Croon, Robin
and Segovia-Lizano, Daniela
and Finglas, Paul
and Vanden Abeele, Vero
and Verbert, Katrien",
title="An Explanation Interface for Healthy Food Recommendations in a Real-Life Workplace Deployment: User-Centered Design Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="11",
volume="13",
pages="e51271",
keywords="food recommender systems",
keywords="personalized nutrition",
keywords="healthy eating",
keywords="human-computer interaction",
keywords="real-life deployment",
keywords="food catering",
keywords="meal recommendations",
keywords="nutritional profile",
keywords="transparency",
abstract="Background: Despite widespread awareness of healthy eating principles, many individuals struggle to translate this knowledge into consistent, sustainable dietary change. Food recommender systems, increasingly used in various settings, offer the potential for personalized guidance and behavior change support. However, traditional approaches may prioritize user preferences or popularity metrics without sufficiently considering long-term nutritional goals. This can inadvertently reinforce unhealthy eating patterns. Emerging research suggests that incorporating explanations into recommender systems can increase transparency, promote informed decision-making, and potentially influence food choices. Yet, the effectiveness of explanations in promoting healthy choices within complex, real-world food environments remain largely unexplored. Objective: This study aims to investigate the design, implementation, and preliminary evaluation of a food recommender system that integrates explanations in a real-world food catering application. We seek to understand how such a system can promote healthy choices while addressing the inherent tensions between user control, meal variety, and the need for nutritionally sound recommendations. Specifically, our objectives are to (1) identify and prioritize key design considerations for food recommenders that balance personalization, nutritional guidance, and user experience; and (2) conduct a proof-of-principle study in a real-life setting to assess the system's effect on user understanding, trust, and potentially on dietary choices. Methods: An iterative, user-centered design process guided the development and refinement of the system across 4 phases: (Phase 0) an exploratory qualitative study (N=26) to understand stakeholder needs and initial system impressions, (Phases 1 and 2) rapid prototyping in real-life deployments (N=45 and N=16, respectively) to iteratively improve usability and features, and (Phase 3) a proof-of-principle study with employees (N=136) to evaluate a set of design goals. We collected a mix of data, including usage logs, pre- and post-study questionnaires, in-app feedback, and a pre- and post--Food Frequency Questionnaire to establish nutritional profiles. Results: Although we experienced a high drop-out (77\% after 7 weeks), motivated and remaining participants valued personalization features, particularly the ability to configure allergies and lifestyle preferences. Explanations increased understanding of recommendations and created a sense of control, even when preferences and healthy options did not fully align. However, a mismatch persisted between individual preferences and nutritionally optimal recommendations. This highlights the design challenge of balancing user control, meal variety, and the promotion of healthy eating. Conclusions: Integrating explanations into personalized food recommender systems might be promising for supporting healthier food choices and creating a more informed understanding of dietary patterns. Our findings could highlight the importance of balancing user control with both the practical limitations of food service settings and the need for nutritionally sound recommendations. While fully resolving the tension between immediate preferences and long-term health goals is an ongoing challenge, explanations can play a crucial role in promoting more conscious decision-making. ",
doi="10.2196/51271",
url="https://mhealth.jmir.org/2025/1/e51271"
}


@Article{info:doi/10.2196/52380,
author="Bennett, Grace
and Yang, Shuhua
and Bardon, A. Laura
and Timon, M. Claire
and Gibney, R. Eileen",
title="Expansion and Assessment of a Web-Based 24-Hour Dietary Recall Tool, Foodbook24, for Use Among Diverse Populations Living in Ireland: Comparative Analysis",
journal="Online J Public Health Inform",
year="2025",
month="Feb",
day="7",
volume="17",
pages="e52380",
keywords="dietary assessment",
keywords="ethnic diets",
keywords="dietary records",
keywords="web-based tools",
keywords="diverse intake",
abstract="Background: Currently, the methods used to collect dietary intake data in Ireland are inflexible to the needs of certain populations, who are poorly represented in nutrition and health data as a result. As the Irish population is becoming increasingly diverse, there is an urgent need to understand the habitual food intake and diet quality of multiple population subgroups, including different nationalities and ethnic minorities, in Ireland. Foodbook24 is an existing web-based 24-hour dietary recall tool, which has previously been validated for use within the general Irish adult population. Because of its design, Foodbook24 can facilitate the improved inclusion of dietary intake assessment in Ireland. Objective: We aimed to examine the suitability of expanding the Foodbook24 tool, improving the reliability and accuracy of dietary intake data collected among prominent nationalities in Ireland. Methods: This study consisted of three distinct parts: (1) expansion of Foodbook24, (2) testing its usability (ie, acceptability study), and (3) examining the accuracy (ie, comparison study) of the updated Foodbook24 tool. To expand Foodbook24, national survey data from Brazil and Poland were reviewed and commonly consumed food items were added to the food list. All foods were translated into Polish and Portuguese. The acceptability study used a qualitative approach whereby participants provided a visual record of their habitual diet. The comparison study consisted of one 24-hour dietary recall using Foodbook24 and one interviewer-led recall completed on the same day, repeated again 2 weeks later. Comparison study data were analyzed using Spearman rank correlations, Mann-Whitney U tests, and $\kappa$ coefficients. Results: The expansion of the Foodbook24 food list resulted in 546 additional foods. The acceptability study reported that 86.5\% (302/349) of foods listed by participants were available in the updated food list. From the comparison study, strong and positive correlations across 8 food groups (44\% of a total of 18 food groups) and 15 nutrients (58\% of a total of 26 nutrients) were identified (r=0.70-0.99). Only intakes of potatoes and potato dishes and nuts, herbs, and seeds significantly differed across methods of assessment, where correlations across these food groups were low (r=0.56 and r=0.47, respectively). The incidence of food omissions varied across samples, with Brazilian participants omitting a higher percentage of foods in self-administered recalls than other samples (6/25, 24\% among the Brazilian vs 5/38, 13\% among the Irish cohort). Conclusions: The updated food list is representative of most foods consumed by Brazilian, Irish, and Polish adults in Ireland. Dietary intake data reported in Foodbook24 are not largely different from food groups and nutrient intakes reported via traditional methods. This study has demonstrated that Foodbook24 may be appropriate for use in future research investigating the dietary intakes of Brazilian, Irish, and Polish groups in Ireland. ",
doi="10.2196/52380",
url="https://ojphi.jmir.org/2025/1/e52380",
url="http://www.ncbi.nlm.nih.gov/pubmed/39919284"
}


@Article{info:doi/10.2196/64739,
author="Oono, Fumi
and Matsumoto, Mai
and Ogata, Risa
and Suga, Mizuki
and Murakami, Kentaro",
title="Description of Weight-Related Content and Recommended Dietary Behaviors for Weight Loss Frequently Reposted on X (Twitter) in English and Japanese: Content Analysis",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="7",
volume="27",
pages="e64739",
keywords="social networking service",
keywords="X, Twitter",
keywords="web-based health information",
keywords="dieting",
keywords="weight loss",
keywords="content analysis",
keywords="digital health",
keywords="weight control",
keywords="weight",
keywords="social media",
keywords="diet",
keywords="dietary behavior",
keywords="obesity",
keywords="eating disorders",
keywords="public perceptions",
abstract="Background: Both obesity and underweight are matters of global concern. Weight-related content frequently shared on social media can reflect public recognition and affect users' behaviors and perceptions. Although X (Twitter) is a popular social media platform, few studies have revealed the content of weight-related posts or details of dietary behaviors for weight loss shared on X. Objective: This study aims to describe body weight--related content frequently reposted on X, with a particular focus on dietary behaviors for weight loss, in English and Japanese. Methods: We collected English and Japanese X posts related to human body weight having over 100 reposts in July 2023 using an application programming interface tool. Two independent researchers categorized the contents of the posts into 7 main categories and then summarized recommended weight loss strategies. Results: We analyzed 815 English and 1213 Japanese posts. The most popular main category of the content was ``how to change weight'' in both languages. The Japanese posts were more likely to mention ``how to change weight'' (n=571, 47.1\%) and ``recipes to change weight'' (n=114, 9.4\%) than the English posts (n=195, 23.9\% and n=10, 1.2\%, respectively), whereas the English posts were more likely to mention ``will or experience to change weight'' (n=167, 20.5\%), ``attitudes toward weight status'' (n=78, 9.6\%), and ``public health situation'' (n=44, 5.4\%) than Japanese posts. Among 146 English and 541 Japanese posts about weight loss strategies, the predominant strategies were diet (n=76, 52.1\% in English and n=170, 31.4\% in Japanese) and physical activities (n=56, 38.4\% and n=295, 54.5\%, respectively). The proportion of posts mentioning both diet and physical activity was smaller in Japanese (n=62, 11.5\%) than in English (n=31, 21.2\%). Among 76 English and 170 Japanese posts about dietary behaviors for weight loss, more than 60\% of posts recommended increasing intakes of specific nutrients or food groups in both languages. The most popular dietary component recommended to increase was vegetables in both English (n=31, 40.8\%) and Japanese (n=48, 28.2\%), followed by protein and fruits in English and grains or potatoes and legumes in Japanese. Japanese posts were less likely to mention reducing energy intake; meal timing or eating frequency; or reducing intakes of specific nutrients or food groups than the English posts. The most popular dietary component recommended to decrease was alcohol in English and confectioneries in Japanese. Conclusions: This study characterized user interest in weight management and suggested the potential of X as an information source for weight management. Although weight loss strategies related to diet and physical activity were popular in both English and Japanese, some differences in the details of the strategies were present, indicating that X users are exposed to different information in English and Japanese. ",
doi="10.2196/64739",
url="https://www.jmir.org/2025/1/e64739",
url="http://www.ncbi.nlm.nih.gov/pubmed/39918849"
}


@Article{info:doi/10.2196/53188,
author="Bragg, A. Marie
and Lutfeali, Samina
and Gabler, Godoy Daniela
and Quintana Licona, A. Diego
and Harris, L. Jennifer",
title="Latinx and White Adolescents' Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e53188",
keywords="Latinx",
keywords="Hispanic",
keywords="adolescents",
keywords="marketing",
keywords="celebrities",
keywords="Spanish",
keywords="advertisements",
keywords="products",
keywords="brands",
keywords="food",
keywords="unhealthy",
keywords="beverages",
keywords="diet",
keywords="nutrition",
keywords="consumers",
keywords="intention",
keywords="purchasing",
keywords="attitudes",
keywords="perceptions",
keywords="preferences",
keywords="youth",
abstract="Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents' preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants' ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement---``liking;'' following; commenting; tagging a friend). Results: Latinx (n=436; 48.3\%) and White (n=467; 51.7\%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps?.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of ``liking'' advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. ",
doi="10.2196/53188",
url="https://www.jmir.org/2025/1/e53188"
}


@Article{info:doi/10.2196/54392,
author="Dorhout, Gijsbertha Berber
and Wezenbeek, Nick
and de Groot, M. Lisette C. P. G.
and Grootswagers, Pol",
title="Web-Based Exercise and Nutrition Intervention to Improve Leg Muscle Strength and Physical Functioning in Older Adults: Pre-Post Pilot Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="30",
volume="9",
pages="e54392",
keywords="web-based lifestyle intervention",
keywords="resistance exercise",
keywords="protein intake",
keywords="muscle strength",
keywords="muscle mass",
keywords="older adults",
keywords="web-based exercise",
keywords="nutrition",
keywords="exercise",
keywords="resistance training",
keywords="sarcopenia",
abstract="Background: The lifestyle intervention ProMuscle, which combines resistance exercise and an increased protein intake, was effective in improving muscle strength, muscle mass, and physical functioning in older adults. However, due to a growing shortage of health care professionals, the rapidly growing aging population cannot be personally guided in the future. Therefore, Uni2Move, a scalable web-based variant of ProMuscle, was designed to reach larger groups of older adults without putting additional burden on health care professionals. Objective: The current study investigated the effects of a web-based lifestyle intervention on muscle strength, protein intake, and physical functioning in healthy older adults. In addition, we conducted a qualitative study to gather key insights of the participants involved, as little is known about older adults' perceptions of web-based lifestyle interventions. Methods: A pre-post pilot study was conducted in the Netherlands. In the 24-week intervention, 19 healthy adults aged >55 years were included. They performed resistance training at home twice a week for 24 weeks via web-based workout videos. Videos (45?60 minutes) were recorded by the fitness trainer and mainly focused on training leg muscles. In addition, older adults were advised on increasing protein intake via two web-based consultations by a dietitian in the first 12 weeks and via an e-learning course in the second 12 weeks. Intervention adherence and acceptance was measured in week 25. The 1 repetition maximum knee extension strength, repeated chair rise test, and protein intake were measured at baseline, week 13, and week 25. Linear mixed models were used to test differences over time. Semistructured interviews were used to gather experiences of participants. Atlas.ti version 22 was used to analyze the interviews. Results: The mean age of participants (n=19) at baseline was 69 (SD 7) years. The 1 repetition maximum knee extension strength and repeated chair rise test improved significantly during the 24-week intervention with a mean difference of 7.0 kg (95\% CI 4.8-9.3; P<.001) and ?1.2 seconds (95\% CI ?1.7 to ?0.6; P<.001), respectively. Total protein intake per day did not change, whereas protein intake during breakfast had increased significantly after 13 weeks with a mean difference of 6.9 g (95\% CI 1.1-12.7; P=.01). Qualitative research revealed that advantages of the program included no need to travel and exercising in their own environment. Disadvantages were the lack of physical interaction and no corrections by the trainer. Conclusions: The results of the web-based exercise and nutrition intervention Uni2Move indicate potential improvements of muscle strength and physical functioning in healthy middle-aged and older adults. Providing such lifestyle interventions on the internet could reach an increased number of older adults, providing the opportunity to contribute to the health and independence of the rapidly growing aging population. ",
doi="10.2196/54392",
url="https://formative.jmir.org/2025/1/e54392"
}


@Article{info:doi/10.2196/64277,
author="Perez-Bootello, Javier
and Berna-Rico, Emilio
and Abbad-Jaime de Aragon, Carlota
and Cova-Martin, Ruth
and Goni, Leticia
and Ballester-Martinez, Asuncion
and Jaen-Olasolo, Pedro
and Mehta, Nehal
and Gelfand, M. Joel
and Martinez-Gonzalez, Angel Miguel
and Gonzalez-Cantero, Alvaro",
title="Impact of the Mediterranean Diet on Patients With Psoriasis: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="29",
volume="14",
pages="e64277",
keywords="psoriasis",
keywords="Mediterranean diet",
keywords="MedDiet",
keywords="nutritional intervention",
keywords="olive oil",
keywords="inflammatory disease",
keywords="Impact of the Mediterranean Diet on Patients with Psoriasis",
keywords="MEDIPSO",
keywords="dietary intervention",
keywords="methodological analysis",
keywords="randomized controlled trial",
keywords="RCT",
keywords="clinical trial",
keywords="nutrition",
keywords="diet",
keywords="Europe",
abstract="Background: Psoriasis is an inflammatory disease primarily treated through molecular-targeted therapies. However, emerging evidence suggests that dietary interventions may also play a role in managing inflammation associated with this condition. The Mediterranean diet (MedDiet), prevalent in southern European countries, has been widely recognized for its ability to reduce cardiovascular mortality, largely due to its anti-inflammatory properties. This anti-inflammatory potential has prompted interest in exploring the MedDiet's role in immune-mediated diseases, including psoriasis. Observational studies have indicated potential benefits, such as reductions in the Psoriasis Area and Severity Index. However, there is a need for well-designed clinical trials to address the methodological limitations of these studies and to establish specific dietary recommendations for psoriasis. Objective: This study aims to evaluate the impact of an intensive dietary intervention based on the MedDiet in patients with psoriasis. The study will assess the effects of this intervention on skin involvement, metabolic parameters, and inflammatory cytokines. In addition, the emotional well-being and quality of life of participants will be evaluated using validated questionnaires. A methodological analysis will also be conducted to enhance the design of future large-scale clinical trials. Methods: An open-label, single-blinded (evaluator) randomized controlled trial was designed to assess the impact of a high-intensity MedDiet intervention in patients with mild-to-moderate psoriasis. A total of 38 patients will be randomly assigned into 2 groups---an intervention group receiving the MedDiet intervention and a control group receiving standard care. The intervention group will participate in dietary education sessions aimed at adopting the MedDiet over 4 months, with monthly monitoring by experienced nutritionists. Participants will receive 500 mL of extra virgin olive oil per week, along with informative materials, recipes, and weekly menus. In contrast, the control group will receive standard low-fat diet recommendations without nutritionist monitoring. All participants will undergo a baseline visit, a 2-month follow-up visit, and a final visit at 4 months. Blood tests will be conducted at the beginning and end of the study. This study protocol was approved by the Institutional Review Board of the Hospital Ram{\'o}n y Cajal (Madrid) in July 2023. Results: Enrollment concluded in October 2024, with data collection set to finish by February 2025. The findings will be presented at national and international conferences and published in peer-reviewed journals. Conclusions: This protocol outlines the design of a clinical trial that implements the MedDiet in patients with psoriasis to evaluate its benefits on skin involvement, systemic inflammation, and quality of life. Trial Registration: ClinicalTrials.gov NCT06257641; https://clinicaltrials.gov/study/NCT06257641 International Registered Report Identifier (IRRID): DERR1-10.2196/64277 ",
doi="10.2196/64277",
url="https://www.researchprotocols.org/2025/1/e64277"
}


@Article{info:doi/10.2196/67213,
author="Zuair, Areeg
and Alhowaymel, M. Fahad
and Jalloun, A. Rola
and Alzahrani, S. Naif
and Almasoud, H. Khalid
and Alharbi, H. Majdi
and Alnawwar, K. Rayan
and Alluhaibi, N. Mohammed
and Alharbi, S. Rawan
and Aljohan, M. Fatima
and Alhumaidi, N. Bandar
and Alahmadi, A. Mohammad",
title="Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non--Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="24",
volume="8",
pages="e67213",
keywords="adolescent obesity",
keywords="macronutrient education",
keywords="cardiovascular fitness",
keywords="body composition",
keywords="health literacy",
keywords="body image",
keywords="macronutrient",
keywords="educational",
keywords="obesity",
keywords="weight",
keywords="overweight",
keywords="fitness",
keywords="nutrition",
keywords="diet",
keywords="patient education",
keywords="student",
keywords="school",
keywords="youth",
keywords="adolescent",
keywords="teenager",
keywords="metabolic",
keywords="eating",
keywords="physical activity",
keywords="exercise",
abstract="Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non--weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non--weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and $\chi${\texttwosuperior} tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9\% (36/95), while 50.5\% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial $\eta${\texttwosuperior}=0.268). There was no significant change in students' body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6\% and a retention rate of 72.6\%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non--weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. ",
doi="10.2196/67213",
url="https://pediatrics.jmir.org/2025/1/e67213"
}


@Article{info:doi/10.2196/47837,
author="Huang, Qinyuan
and Zhong, Qinyi
and Zeng, Yanjing
and Li, Yimeng
and Wiley, James
and Wang, Ping Man
and Chen, Jyu-Lin
and Guo, Jia",
title="mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jan",
day="24",
volume="13",
pages="e47837",
keywords="type 2 diabetes",
keywords="mHealth",
keywords="obesity",
keywords="prevention",
keywords="mothers",
abstract="Background: Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)--based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet. Objective: The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months. Methods: A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis. Results: Approximately 85\% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference ($\beta$=--2.24, 95\% CI --4.12 to --0.36; P=.02), modifiable diabetes risk scores ($\beta$=--2.5, 95\% CI --4.57 to --0.44; P=.02), daily steps ($\beta$=1.67, 95\% CI 0.06-3.29; P=.04), self-efficacy for physical activity ($\beta$=1.93, 95\% CI 0.44-3.43; P=.01), social support for physical activity ($\beta$=2.27, 95\% CI 0.80-3.74; P=.002), and physical health satisfaction ($\beta$=0.82, 95\% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P>.05). Conclusions: This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information in managing diabetes risk among mothers with abdominal obesity. The mHealth diabetes prevention program provides a flexible, customized, and resource-saving model for busy mothers. Future research could further explore the efficacy improvement on dietary behaviors to better serve the health care needs of this population. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400090554; https://www.chictr.org.cn/showproj.html?proj=226411 ",
doi="10.2196/47837",
url="https://mhealth.jmir.org/2025/1/e47837"
}


@Article{info:doi/10.2196/68372,
author="Hayek, Joyce
and Dickson, Kelsi
and Lafave, Z. Lynne M.",
title="Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="22",
volume="8",
pages="e68372",
keywords="eHealth",
keywords="early childhood educators",
keywords="ECE",
keywords="early childhood education and care",
keywords="ECEC",
keywords="knowledge synthesis",
keywords="digital technology",
keywords="health technology",
keywords="digital public health",
keywords="eating",
keywords="diet",
abstract="Background: Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators' practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking. Objective: The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness. Methods: This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature. Results: The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53\%). The largest proportion of studies were conducted in the United States (11 studies, 37\%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42\%), physical activity (5 tools, 26\%), or both nutrition and physical activity (6 tools, 32\%). All tools were web based (19 tools, 100\%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57\%) and the United States (3 tools, 43\%). The majority targeted nutrition (4 tools, 57\%) and were primarily web based (6 tools, 86\%), with 1 mobile app (1 tool, 14\%). Conclusions: This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): RR2-10.2196/52252 ",
doi="10.2196/68372",
url="https://pediatrics.jmir.org/2025/1/e68372"
}


@Article{info:doi/10.2196/65122,
author="Hendrie, A. Gilly
and Baird, L. Danielle
and James-Martin, Genevieve
and Brindal, Emily
and Brooker, G. Paige",
title="Weight Loss Patterns and Outcomes Over 12 Months on a Commercial Weight Management Program (CSIRO Total Wellbeing Diet Online): Large-Community Cohort Evaluation Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="15",
volume="27",
pages="e65122",
keywords="obesity",
keywords="obesity management",
keywords="weight loss",
keywords="internet-based intervention, weight management",
abstract="Background: A greater understanding of the effectiveness of digital self-management programs and their ability to support longer-term weight loss is needed. Objective: This study aimed to explore the total weight loss and patterns of weight loss of CSIRO (Commonwealth Scientific and Industrial Research Organisation) Total Wellbeing Diet Online members during their first 12 months of membership and examine the patterns of platform use associated with greater weight loss. Methods: Participants were Australian adults who joined the program between October 2014 and June 2022 and were classified as longer-term members, meaning they completed at least 12 weeks of the program, had baseline and 12-week weight data, and had a paid membership of ?1 year (N=24,035). Weight loss and percentage of starting body weight loss were calculated at 3, 6, 9, and 12 months using 3 statistical approaches: (1) multiple imputations method, (2) all available data, and (3) complete data only. Among members with complete data (6602/24,035, 27.5\%), patterns of weight loss and gain were examined, and how this related to total weight loss and platform use was explored. Results: Members were mostly female (19,972/24,035, 83.09\%), aged 31 to 50 years (9986/24,035, 41.5\%) or 51 to 70 years (12,033/24,035, 50.06\%), and most members were classified as overweight or obese (23,050/24,035, 95.9\%). Using multiple imputations, the average estimated weight loss was 5.9 (SE 0.0245) kg at 12 weeks, 6.7 (SE 0.0348) kg at 6 months, 6.2 (SE 0.0400) kg at 9 months, and 5.5 (SE 0.0421) kg at 12 months. At 12 months, more than half the members (12,573/24,035, 52.3\%) were at least 5\% below their starting body weight and 1 in 4 (5865/24,035, 24.4\%) were at least 10\% below their starting body weight. In the subsample with complete data, the average weight loss at 12 months was 7.8 kg. The most common (961/6602, 14.56\% members) weight loss pattern over the first 12 months was 6 months of weight loss, followed by 6 months of weight maintenance. This group had an average weight loss of 10.6 kg at 12 months (11.9\% of their starting body weight). In a subgroup of participants who consistently lost weight over the 12-month period (284/6602, 4.3\% of the sample), weight loss reached up to 22.3 kg (21.7\% of their starting body weight). Weekly platform use was positively associated with total weight loss (r=0.287; P<.001). Members who used the platform >30 times per week (approximately >4 times/d) were more likely to lose weight in the first 6 months of the program. Conclusions: This commercial weight loss program was shown to be effective, with 1 in 2 members achieving clinically significant results after 1 year. Greater engagement with the platform was associated with consecutive periods of weight loss and greater weight loss success overall. ",
doi="10.2196/65122",
url="https://www.jmir.org/2025/1/e65122"
}


@Article{info:doi/10.2196/58460,
author="Leung, May May
and Mateo, F. Katrina
and Dublin, Marlo
and Harrison, Laura
and Verdaguer, Sandra
and Wyka, Katarzyna",
title="Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="15",
volume="9",
pages="e58460",
keywords="childhood obesity",
keywords="preadolescents",
keywords="racial and ethnic minority populations",
keywords="dietary behaviors",
keywords="BMI",
keywords="digital health",
abstract="Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61\% were female, 62\% were Black, 42\% were Hispanic, 53\% were overweight or obese, and 34\% had an annual household income of <US \$20,000. Participants were randomly assigned to the experimental group (45/89, 50\% received the web-based comic tool), or the comparison group (44/89, 50\% received web-based nutrition newsletters). Primary measures included feasibility and usability at intervention midpoint (T2) and intervention end (T3). Semistructured interviews were conducted at the same time to assess acceptability and satisfaction. Secondary measures, collected at baseline (T1), T2, T3, and at T4, included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar, and junk food intake. Descriptive analyses were conducted for use and usability data. Interviews were systematically analyzed to facilitate identification of patterns and themes. Secondary data were analyzed using descriptive statistics. Within- and between-group effect sizes were reported. Results: In total, 72\% (33/45) and 60\% (27/44) of the experimental and comparison groups, respectively, accessed their tool weekly. The mean total usability score was high and moderately high for the experimental and comparison groups, respectively (mean 4.01, SD 0.37 and mean 3.81, SD 0.51; P=.048), based on a 5-point Likert scale). Children in both groups found the tool acceptable, and few reported difficulties logging in or accessing content. Between-group effect sizes for beliefs and attitudes related to dietary intake, while favoring the experimental group at T3, were in the small range. These improvements in both groups were largely diminished by T4. However, between-group effect sizes for behaviors related to fruit, vegetable, and water intake, favoring the experimental group, were medium to large and were maintained at T4. Conclusions: This pilot feasibility study suggests that an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in racial and ethnic minority preadolescents. However, further research, including a full-scale randomized controlled trial, is warranted to determine the effectiveness of Intervention INC. Trial Registration: ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/study/NCT03165474 International Registered Report Identifier (IRRID): RR2-10.2196/10682 ",
doi="10.2196/58460",
url="https://formative.jmir.org/2025/1/e58460",
url="http://www.ncbi.nlm.nih.gov/pubmed/39813083"
}


@Article{info:doi/10.2196/54506,
author="Montoya, Alana
and Mao, Lingchao
and Drewnowski, Adam
and Chen, Joshua
and Shi, Ella
and Liang, Aileen
and Weiner, J. Bryan
and Su, Yanfang",
title="Influencers in Policy Fields on Social Media: Global Longitudinal Study of Dietary Sodium Reduction Posts, 2006-2022",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="30",
volume="26",
pages="e54506",
keywords="policy field",
keywords="sodium intake",
keywords="sodium consumption",
keywords="cardiovascular disease",
keywords="social media",
keywords="health education",
keywords="health promotion",
keywords="dissemination",
keywords="influence",
keywords="Twitter",
keywords="X",
keywords="activity",
keywords="priority",
keywords="originality",
keywords="popularity",
abstract="Background: Excessive sodium intake is a major concern for global public health. Despite multiple dietary guidelines, population sodium intakes are above recommended levels. Lack of health literacy could be one contributing issue and contemporary health literacy is largely shaped by social media. Objective: This study aims to quantify the posting behaviors and influence patterns on dietary sodium--related content by influencers in the policy field on X (formerly Twitter) across time. Methods: We first identified X users with a scope of work related to dietary sodium and retrieved their posts (formerly Tweets) from 2006 to 2022. Users were categorized into the policy groups of outer-setting organization, inner-setting organization, or individual, based on their role in the conceptual policy field. Network analysis was used to analyze interactions among users and identify the top influencers in each policy group. A 4D influence framework was applied to measure the overall influence, activity, priority, originality, and popularity scores. These measures were used to reveal the user-level, group-level, and temporal patterns of sodium-related influence. Results: We identified 78 users with content related to dietary sodium, with 1,099,605 posts in total and 14,732 dietary sodium posts. There was an increasing volume of sodium posts from 2010 to 2015; however, the trend has been decreasing since 2016, especially among outer-setting organizations. The top influencers from the three policy groups were the World Health Organization (WHO), the American Heart Association, and Tom Frieden. Simon Capewell and the WHO ranked the highest in activity; the World Action on Salt, Sugar, and Health and Action on Salt had the highest priority for dietary sodium content; General Mills and Tom Frieden had the highest originality; and WHO, Harvard University School of Medicine, and Tom Frieden received the highest popularity. Outer-setting organizations tend to interact with more users in the network compared to inner-setting organizations and individuals, while inner-setting organizations tend to receive more engagements from other users in the network than the other two groups. Monthly patterns showed a significant peak in the number of sodium posts in March compared with other months. Conclusions: Despite the increased use of social media, recent trends of sodium intake education on social media are decreasing and the priority of sodium among other topics is low. To improve policy implementation effectiveness and meet recommended dietary targets, there is an increasing need for health leaders to consistently and collectively advocate for sodium intake reduction on social media. ",
doi="10.2196/54506",
url="https://www.jmir.org/2024/1/e54506"
}


@Article{info:doi/10.2196/59614,
author="Richter, Franziska
and Kronziel, Louisa Lea
and K{\"o}nig, Inke
and Langer, Thorsten
and Gebauer, Judith",
title="Implementation of Regular Lifestyle Counseling During Long-Term Follow-Up Care of Childhood Cancer Survivors: Monocentric Prospective Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="26",
volume="10",
pages="e59614",
keywords="lifestyle counseling",
keywords="long-term follow-up",
keywords="childhood cancer survivors",
keywords="physical activity",
keywords="metabolic disorders",
keywords="cancer survivor",
keywords="treatment-related",
keywords="risk of obesity",
keywords="metabolic syndrome",
keywords="healthy lifestyle",
keywords="morbidity",
keywords="patient",
keywords="hypercholesterolemia",
keywords="diabetes mellitus",
keywords="health care professionals",
abstract="Background: Many childhood cancer survivors (CCS) develop treatment-related late effects, including an increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long-term follow-up (LTFU). Objective: We implemented a new form of care to decrease the long-term morbidity among CCS and to gain new insights into the lifestyle of those patients. Methods: Over a 1-year study period, lifestyle counseling was integrated into LTFU care. Metabolic disorders, including hypercholesterolemia, diabetes mellitus, overweight or underweight, and low activity levels, were assessed as screening parameters for various risk groups. The perspectives of CCS, physicians, and sports scientists were compared to identify those with the highest needs. Each lifestyle counseling included general recommendations for physical activity, as well as an assessment of individual preferences for and barriers to the implementation of a healthy lifestyle. A follow-up appointment after 1 month was performed. Results: Of the 155 CCS aged 18 to 63 years (n=100, 65\% female and n=55, 35\% male), 112 (72\%) had an indication for lifestyle counseling, identified by physicians, sports scientists, or the CCS themselves. Metabolic disorders affected 45\% (n=70) of these CCS, and 46\% (n=72) did not meet recommended activity levels. A total of 120 (77\%) CCS received lifestyle counseling, including 8 initially uninterested individuals who became open to recommendations. Those with intensive cancer treatment history showed the greatest need. A total of 65 (54\%) CCS were advised to change their lifestyle in both areas (diet and exercise) while 51 (43\%) CCS received recommendations for only exercise (n=43 CCS, 36\%) or diet (n=8 CCS, 7\%). A total of 4 (3\%) CCS, although interested in counseling, received no advice, as they already met the recommendations. Follow-up revealed high adherence to recommendations and successful integration into daily lives. In total, 97\% (n=150) of survivors indicated that the provision of lifestyle counseling during LTFU would be generally beneficial. Conclusions: Incorporating specialized health care professionals such as sports scientists into survivorship care enhances the multidisciplinary approach of LTFU care. Promoting a healthy lifestyle by offering guideline-based lifestyle counseling is broadly accepted among CCS and may reduce long-term morbidity. ",
doi="10.2196/59614",
url="https://cancer.jmir.org/2024/1/e59614"
}


@Article{info:doi/10.2196/48323,
author="van Dam, Lotte
and Christensen, H{\o}jlund Sine
and Tetens, Inge
and Riley III, William
and Timmer, Mari{\"e}lle
and Suciu Jr, George
and Marin, Iuliana
and De Groot, Lisette
and Grootswagers, Pol",
title="Developing a Digital Tool to Calculate Protein Quality in Plant-Based Meals of Older Adults: User Engagement Design Approach With End Users",
journal="J Particip Med",
year="2024",
month="Dec",
day="19",
volume="16",
pages="e48323",
keywords="digital tool",
keywords="protein quality",
keywords="user engagement design approach",
keywords="plant-based diets",
keywords="healthy ageing",
keywords="mobile phone",
abstract="Background: The global shift toward plant-based diets has been increasing, with more people making the transition for various reasons. In vulnerable subgroups such as older adults, the transition to plant-based diets deserves attention due to the potentially detrimental consequences of lower protein quantity and quality. Objective: We aimed to develop a digital tool that ensures adequate protein quality in plant-based meals for older adults experiencing low protein intake through an interdisciplinary collaboration and user engagement with potential end users. Methods: Three focus group interviews of Dutch and Danish dietitians and older adults as potential end users were conducted to identify their needs, preferences, and deal-breakers. Focus group interviews were based on a user-task-environment analysis, the Walt Disney method, the brainwriting method, and a cognitive walkthrough. The interview transcripts were analyzed with a thematic analysis. The front end and backend development of a potential tool took place in parallel and was well-synced to the focus group interviews. Results: Both dietitians and older adults from Dutch and Danish sites expressed high interest in a tool that provides feedback and background information on protein quality, sustainability, and nutrients or micronutrients. The user-task-environment analysis delivered input among others that dietitians and older adults are good potential users, the tool should be functional as an app as well as a website and the tool should provide preprogrammed meals or recipes. The Walt Disney method delivered usable and realistic solutions to the 4 challenges presented. Thirty-two percent of the solutions on all themes presented with the brainwriting method appeared to be highly feasible and relevant, having the potential to be implemented in a tool. The cognitive walkthrough identified certain screens as unclear, necessitating revisions for improved understandability, for example, the need for explanation in selecting food item filters is shown in screenshot 2, with an overall usability score of 59\%. Conclusions: Our user engagement design approach resulted in a prototype that ensured end users' wishes and needs, with a finetuned output tested in focus groups. We conclude that our user engagement design approach was a suitable and meaningful stepwise approach to ensure the relevance of the tool and identify potential barriers. The focus group results indicate that dietitians have a clear understanding and need for a tool to aid in meal planning for enhanced protein quality, highlighting its absence in their current resources despite increasing demands arising from the protein transition. Conversely, for older adults, the introduction of a digital tool appears less appropriate; instead, there is a necessity for foundational education on protein quality before such a tool can be effectively used. Future studies are needed to further implement the prototype into practice. ",
doi="10.2196/48323",
url="https://jopm.jmir.org/2024/1/e48323"
}


@Article{info:doi/10.2196/60155,
author="Kwan, Cho Rick Yiu
and Law, Sze Queenie Pui
and Tsang, Yee Jenny Tsun
and Lam, Hin Siu
and Wang, To Kam
and Sin, Kan Olive Shuk
and Cheung, Ki Daphne Sze",
title="The Effect of the Mediterranean Diet--Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Dec",
day="13",
volume="11",
pages="e60155",
keywords="cognitive frailty",
keywords="gamification",
keywords="health education",
keywords="Mediterranean diet",
keywords="home based",
keywords="cognitive training",
keywords="older adults",
keywords="geriatric",
keywords="elderly",
keywords="cognitive function",
keywords="intervention",
keywords="nutritional education",
keywords="cognitive impairment",
keywords="dementia",
abstract="Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=--0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=--0.728, P=.009), cognitive function (r=--0.752, P=.007), physical frailty (r=--0.668, P=.02), and walking speed (r=--0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 ",
doi="10.2196/60155",
url="https://rehab.jmir.org/2024/1/e60155"
}


@Article{info:doi/10.2196/51701,
author="Almenara, A. Carlos
and Gulec, Hayriye",
title="Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach",
journal="JMIR Infodemiology",
year="2024",
month="Dec",
day="11",
volume="4",
pages="e51701",
keywords="consumer health informatics",
keywords="cyberattack risk",
keywords="data mining",
keywords="Google",
keywords="information seeking",
keywords="weight loss",
keywords="online health information",
keywords="website analysis",
keywords="digital health",
keywords="internet search",
abstract="Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, ``People Also Ask'' featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved ``Health'' (104/623, 16.69\%), ``Personal Pages and Blogs'' (91/623, 14.61\%), ``Nutrition and Diet'' (48/623, 7.7\%), and ``Exercise'' (34/623, 5.46\%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. ",
doi="10.2196/51701",
url="https://infodemiology.jmir.org/2024/1/e51701"
}


@Article{info:doi/10.2196/55243,
author="Mateo-Orcajada, Adri{\'a}n
and Ponce-Ram{\'i}rez, M. Cristina
and Abenza-Cano, Luc{\'i}a
and Vaquero-Crist{\'o}bal, Raquel",
title="Effects of 10 Weeks of Walking With Mobile Step-Tracking Apps on Body Composition, Fitness, and Psychological State in Adolescents Who Are Overweight and Obese: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="10",
volume="26",
pages="e55243",
keywords="adolescents",
keywords="obesity",
keywords="physical activity",
keywords="overweight",
keywords="mobile app",
keywords="physical education",
abstract="Background: In recent decades, physical activity intervention programs have been developed to reduce overweight and obesity in adolescents. However, this population is considered hard to reach in physical activity programs due to lack of adherence and poor results. Interventions with mobile phones in the adolescent population with normal weight have shown benefits, so this line of research may provide benefits in adolescents with overweight or obesity, although it has not yet been explored in the scientific literature. Objective: This study aims to determine the changes produced by a 10-week intervention promoted during school lessons on physical education using step tracker mobile apps in out-of-school hours on physical activity, adherence to the Mediterranean diet, body composition, and the physical condition of adolescents who are overweight and obese, and to analyze the changes achieved by the 10-week intervention on the psychological state of adolescents who are overweight and obese. Methods: The study was based on a randomized controlled trial with an initial sample of 50 adolescents aged between 12 and 16 years (from the first to the fourth years of compulsory secondary education), whose body composition, physical activity level, physical condition, and psychological state were measured. Participants were divided into an experimental group (EG) and a control group (CG), where the EG performed a series of walking steps with a mobile app in their free time outside physical education classes. Adolescents in the CG continued to perform their physical activities as normal but did not use any mobile apps. Inclusion in the EG and CG was randomized, and the researchers were blinded. Results: An increase was found in the EG in corrected arm girth (mean difference --0.46; P=.05), curl-up repetitions (mean difference --6.35; P=.02) and push-up repetitions (mean difference --2.27; P=.04) after the intervention. In the CG, there was a significant increase in hip girth (mean difference --1.37; P=.05), corrected thigh girth (mean difference --1.28; P=.04), and muscle mass (mean difference --0.87; P=.04), as well as a significant decrease in competence (mean difference 3.08; P=.03). The covariates gender and age showed an effect on corrected arm girth (gender: P=.04), curl-up repetitions (gender: P=.04) and push-up repetitions (gender: P=.04) in the EG; while in the CG it affected corrected thigh girth (gender: P=.04), adherence to the Mediterranean diet (gender: P=.04 and age: P=.047) competence (gender: P=.04 and age: P=.04) and relatedness (gender: P=.05 and age: P=.04). No significant differences were found when comparing changes in the CG and EG. Conclusions: A 10-week program of mobile app use by adolescents who are overweight and obese for physical activity outside of school hours does not appear effective in producing improvements in body composition, physical fitness, or adequate psychological state as it does not appear to significantly increase physical activity. Trial Registration: ClinicalTrials.gov NCT06089876; http://clinicaltrials.gov/ct2/show/NCT06089876 ",
doi="10.2196/55243",
url="https://www.jmir.org/2024/1/e55243",
url="http://www.ncbi.nlm.nih.gov/pubmed/39656510"
}


@Article{info:doi/10.2196/52032,
author="Ali, H. Shahmir
and Rahman, Fardin
and Kuwar, Aakanksha
and Khanna, Twesha
and Nayak, Anika
and Sharma, Priyanshi
and Dasraj, Sarika
and Auer, Sian
and Rouf, Rejowana
and Patel, Tanvi
and Dhar, Biswadeep",
title="Rapid, Tailored Dietary and Health Education Through A Social Media Chatbot Microintervention: Development and Usability Study With Practical Recommendations",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="9",
volume="8",
pages="e52032",
keywords="social media",
keywords="chatbot",
keywords="conversational agent",
keywords="intervention",
keywords="diet",
keywords="health education",
keywords="feasibility",
keywords="microintervention",
keywords="innovation",
keywords="dietary education",
keywords="social media chatbot",
keywords="public health professional",
keywords="young adult",
keywords="Asian",
keywords="curriculum",
abstract="Background: There is an urgent need to innovate methods of health education, which can often be resource- and time-intensive. Microinterventions have shown promise as a platform for rapid, tailored resource dissemination yet have been underexplored as a method of standardized health or dietary education; social media chatbots display unique potential as a modality for accessible, efficient, and affordable educational microinterventions. Objective: This study aims to provide public health professionals with practical recommendations on the use of social media chatbots for health education by (1) documenting the development of a novel social media chatbot intervention aimed at improving dietary attitudes and self-efficacy among South Asian American young adults and (2) describing the applied experiences of implementing the chatbot, along with user experience and engagement data. Methods: In 2023, the ``Roti'' chatbot was developed on Facebook and Instagram to administer a 4-lesson tailored dietary health curriculum, informed by formative research and the Theory of Planned Behavior, to 18- to 29-year-old South Asian American participants (recruited through social media from across the United States). Each lesson (10-15 minutes) consisted of 40-50 prescripted interactive texts with the chatbot (including multiple-choice and open-response questions). A preintervention survey determined which lesson(s) were suggested to participants based on their unique needs, followed by a postintervention survey informed by the Theory of Planned Behavior to assess changes in attitudes, self-efficacy, and user experiences (User Experience Questionnaire). This study uses a cross-sectional design to examine postintervention user experiences, engagement, challenges encountered, and solutions developed during the chatbot implementation. Results: Data from 168 participants of the intervention (n=92, 54.8\% Facebook; n=76, 45.2\% Instagram) were analyzed (mean age 24.5, SD 3.1 years; n=129, 76.8\% female). Participants completed an average of 2.6 lessons (13.9 minutes per lesson) and answered an average of 75\% of questions asked by the chatbot. Most reported a positive chatbot experience (User Experience Questionnaire: 1.34; 81/116, 69.8\% positive), with pragmatic quality (ease of use) being higher than hedonic quality (how interesting it felt; 88/116, 75.9\% vs 64/116, 55.2\% positive evaluation); younger participants reported greater hedonic quality (P=.04). On a scale out of 10 (highest agreement), participants reported that the chatbot was relevant (8.53), that they learned something new (8.24), and that the chatbot was helpful (8.28). Qualitative data revealed an appreciation for the cheerful, interactive messaging of the chatbot and outlined areas of improvement for the length, timing, and scope of text content. Quick replies, checkpoints, online forums, and self-administered troubleshooting were some solutions developed to meet the challenges experienced. Conclusions: The implementation of a standardized, tailored health education curriculum through an interactive social media chatbot displayed strong feasibility. Lessons learned from challenges encountered and user input provide a tangible roadmap for future exploration of such chatbots for accessible, engaging health interventions. ",
doi="10.2196/52032",
url="https://formative.jmir.org/2024/1/e52032"
}


@Article{info:doi/10.2196/56573,
author="Zhang, Xinmeng
and Kang, Kaidi
and Yan, Chao
and Feng, Yubo
and Vandekar, Simon
and Yu, Danxia
and Rosenbloom, Trent S.
and Samuels, Jason
and Srivastava, Gitanjali
and Williams, Brandon
and Albaugh, L. Vance
and English, J. Wayne
and Flynn, R. Charles
and Chen, You",
title="Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="9",
volume="26",
pages="e56573",
keywords="patient portal",
keywords="patient engagement",
keywords="bariatric surgery",
keywords="retrospective",
keywords="longitudinal study",
keywords="data-driven",
keywords="weight loss",
keywords="obesity",
keywords="electronic health records",
keywords="postoperative care",
abstract="Background: Bariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post--bariatric surgery weight loss remains unclear. Objective: This study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery. Methods: This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients' portal engagements at these stages and the percentage of BMI reduction (\%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient's age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. Results: The study included 1415 patients, predominantly female (n=1145, 80.9\%), with a racial composition of 76.9\% (n=1088) White and 19.9\% (n=282) Black. Overall, 805 (56.9\%) patients underwent Roux-en-Y gastric bypass and 610 (43.1\%) underwent sleeve gastrectomy. By 1 year after surgery, the median \%BMIR was 31.5\% (IQR 25.2\%-36.8\%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with \%BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37\% (95\% CI --0.55\% to --0.18\%; P<.001) lower expected \%BMIR at 3 months, a 1.11\% (95\% CI 0.82\%-1.41\%; P<.001) higher expected \%BMIR at 6 months, and a 0.78\% (95\% CI 0.25\%-1.31\%; P=.004) higher expected \%BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36\% (95\% CI --0.69 to --0.03; P=.03) lower expected \%BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with \%BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower \%BMIR at 3 months and a higher \%BMIR at both 6 and 12 months (all P<.05). Conclusions: Higher patient portal engagement within 3 months after surgery---suggestive of stronger adherence to postoperative instructions and improved communication with care teams---is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality. ",
doi="10.2196/56573",
url="https://www.jmir.org/2024/1/e56573"
}


@Article{info:doi/10.2196/58682,
author="Oei, Krista
and Choi, EY Elizabeth
and Bar-Dayan, Alisa
and Stinson, N. Jennifer
and Palmert, R. Mark
and Alfonsi, E. Jeffrey
and Hamilton, Jill",
title="An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="2",
volume="8",
pages="e58682",
keywords="obesity",
keywords="weight management",
keywords="dietary assessment",
keywords="nutrition",
keywords="adolescent",
keywords="digital health app",
keywords="mHealth",
keywords="mobile health",
keywords="image recognition",
keywords="teens",
keywords="weight",
keywords="youth",
keywords="diet",
keywords="dietary",
keywords="dietary app",
keywords="usability",
keywords="feasibility",
keywords="pilot randomized controlled trial",
keywords="obesity management",
keywords="nutritional",
keywords="user",
keywords="patient engagement",
keywords="mobile phone",
abstract="Background: Adolescence is a period of increased susceptibility to developing obesity-related health issues due to poor eating patterns and increased sedentary behaviors. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. The use of image-recognition dietary assessment apps in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal setting. Nutritional data can be displayed for health care providers (HCPs) via the Clinician Portal, while the data are presented to the user in a manner that minimizes the focus on calorie counting. Objective: This study aims to evaluate the usability and feasibility of E4W, a mobile health app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. Methods: The overall study was conducted in 2 phases to refine and evaluate E4W. In Phase 1, usability was tested through 3 iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI?97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for HCPs (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. In Phase 2, a pilot randomized controlled trial of 32 adolescents (16 adolescents enrolled in the experimental group for 1 month, and 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, midstudy, and 1 month following their baseline visit to discuss goals and eating patterns. The control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. The primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. Results: Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient, and well-liked by patients and HCPs. Feasibility testing revealed high patient acceptability scores. However, significant technical challenges were encountered. Although the use of E4W did not significantly impact patient engagement (control: mean 0.9, SD 0.7; experimental: mean 1.7, SD 1.9; P=.14), there were outliers in the experimental group with very high engagement and improved self-reported efficacy. Overall, there was no improvement in dietary intake, although assessment was hindered by poor adherence to traditional methods of food logging. Conclusions: E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted and planned to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. Trial Registration: ClinicalTrials.gov NCT05548868; https://clinicaltrials.gov/study/NCT05548868 ",
doi="10.2196/58682",
url="https://formative.jmir.org/2024/1/e58682",
url="http://www.ncbi.nlm.nih.gov/pubmed/39621405"
}


@Article{info:doi/10.2196/59455,
author="Meyer, Lene
and K{\o}ster-Rasmussen, Rasmus
and Christiansen, Lindahl Ann-Kathrin
and Heitmann, Lilienthal Berit
and Vesterlund, Kingo Gitte
and Larsen, Christian Sofus
and Specht, Olmer Ina
and Thorsteinsdottir, Fanney
and Steinbo, Fr{\o}hlke Emma Katrine
and Appel, Lundmark Clara
and Sigurdardottir, Agusta Gudrun
and Reventlow, Susanne
and Waldorff, Boch Frans
and Sandholdt, Thiel Catharina",
title="Developing a Weight-Neutral Health Intervention in Denmark: Protocol for a Co-Design Process",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="29",
volume="10",
pages="e59455",
keywords="obesity",
keywords="weight management",
keywords="complex intervention",
keywords="patient engagement",
keywords="health intervention",
keywords="Denmark",
keywords="Danish",
keywords="lifestyle",
keywords="weight loss",
keywords="weight reduction",
keywords="stigma",
keywords="neutral health",
keywords="human-centered design",
keywords="dissemination",
keywords="podcast",
keywords="social media",
keywords="feasibility study",
keywords="public health",
keywords="surveillance",
abstract="Background: Lifestyle interventions for weight loss are generally ineffective in achieving clinically meaningful long-term reductions in body weight and may contribute to negative behavior such as weight cycling or disordered eating. Negative focus on high weight may also contribute to weight stigma. Weight stigma includes negative attitudes and discriminatory behavior toward people with big bodies and can result in psychological stress and unfavorable health outcomes. Taken together, it is possible that the potential harms of lifestyle-based weight loss interventions may exceed the potential benefits. Weight-neutral health (WNH) has emerged as an alternative strategy advocating for size diversity, intuitive eating, and joyful physical movement, all without placing emphasis on weight reduction. Objective: This protocol outlines the study design for the co-design process of developing a WNH complex intervention, engaging relevant stakeholders in Denmark. Methods: We base our understanding of WNH on the principles from Health at Every Size: body acceptance, joyful movement, intuitive eating, and weight stigma reduction. The co-design development process is based on the Medical Research Council's framework for complex interventions and applies methods from human-centered design through 4 iterative design phases of engaging stakeholders---discover: search existing literature, and conduct interviews with Danish municipal stakeholders working with WNH and other expert stakeholders; define: coproduction of seminars with health professionals (HPs) with knowledge of WNH, and semistructured interviews with people with BMI?30 kg/m2 who have participated in existing WNH interventions; design: content-creating workshops with HPs and people with BMI?30 kg/m2; and validate: evaluate seminars, plan feasibility, and produce materials. The data will be analyzed thematically to build a scaffold for the intervention activities and components. In further analysis, we will explore how health is performed, meaning the actions and dialogues that arise when dealing with health guidelines, the societal body, weight, and health expectations, in the context of the intervention. Results: The project is fully funded. As of August 2024, the co-design process was in the closing phase. In total, 15 HPs were included, some of whom have larger body sizes. This provides a dual perspective, combining their personal experiences of living with a high BMI with their professional expertise. In total, 16 people with BMI?30 kg/m2 have generously shared their experiences with WNH programs, including the difficulties of moving away from external demands and personal wishes for weight loss. Their contributions have nuanced and unfolded our understanding of the principles of WNH in a Danish setting. Conclusions: The intervention designed in and from the co-design process will be tested for feasibility in 2025. The findings from the feasibility study will inform a future randomized controlled trial and present novel findings in the field of health management. The long-term goal is to implement the intervention in a Danish municipal setting free of charge. ",
doi="10.2196/59455",
url="https://publichealth.jmir.org/2024/1/e59455"
}


@Article{info:doi/10.2196/54557,
author="Zheng, Jiakun
and Wang, Junjie
and Shen, Jing
and An, Ruopeng",
title="Artificial Intelligence Applications to Measure Food and Nutrient Intakes: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e54557",
keywords="food",
keywords="nutrient",
keywords="diet",
keywords="artificial intelligence",
keywords="machine learning",
keywords="deep learning",
keywords="neural networks",
keywords="computer vision",
keywords="natural language processing",
keywords="measurement",
keywords="AI",
keywords="food intake",
keywords="systematic literature",
keywords="dietary assessments",
keywords="AI-based",
keywords="disease management",
keywords="mobile phone",
abstract="Background: Accurate measurement of food and nutrient intake is crucial for nutrition research, dietary surveillance, and disease management, but traditional methods such as 24-hour dietary recalls, food diaries, and food frequency questionnaires are often prone to recall error and social desirability bias, limiting their reliability. With the advancement of artificial intelligence (AI), there is potential to overcome these limitations through automated, objective, and scalable dietary assessment techniques. However, the effectiveness and challenges of AI applications in this domain remain inadequately explored. Objective: This study aimed to conduct a scoping review to synthesize existing literature on the efficacy, accuracy, and challenges of using AI tools in assessing food and nutrient intakes, offering insights into their current advantages and areas of improvement. Methods: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive literature search was conducted in 4 databases---PubMed, Web of Science, Cochrane Library, and EBSCO---covering publications from the databases' inception to June 30, 2023. Studies were included if they used modern AI approaches to assess food and nutrient intakes in human subjects. Results: The 25 included studies, published between 2010 and 2023, involved sample sizes ranging from 10 to 38,415 participants. These studies used a variety of input data types, including food images (n=10), sound and jaw motion data from wearable devices (n=9), and text data (n=4), with 2 studies combining multiple input types. AI models applied included deep learning (eg, convolutional neural networks), machine learning (eg, support vector machines), and hybrid approaches. Applications were categorized into dietary intake assessment, food detection, nutrient estimation, and food intake prediction. Food detection accuracies ranged from 74\% to 99.85\%, and nutrient estimation errors varied between 10\% and 15\%. For instance, the RGB-D (Red, Green, Blue-Depth) fusion network achieved a mean absolute error of 15\% in calorie estimation, and a sound-based classification model reached up to 94\% accuracy in detecting food intake based on jaw motion and chewing patterns. In addition, AI-based systems provided real-time monitoring capabilities, improving the precision of dietary assessments and demonstrating the potential to reduce recall bias typically associated with traditional self-report methods. Conclusions: While AI demonstrated significant advantages in improving accuracy, reducing labor, and enabling real-time monitoring, challenges remain in adapting to diverse food types, ensuring algorithmic fairness, and addressing data privacy concerns. The findings suggest that AI has transformative potential for dietary assessment at both individual and population levels, supporting precision nutrition and chronic disease management. Future research should focus on enhancing the robustness of AI models across diverse dietary contexts and integrating biological sensors for a holistic dietary assessment approach. ",
doi="10.2196/54557",
url="https://www.jmir.org/2024/1/e54557"
}


@Article{info:doi/10.2196/59145,
author="Palacios, E. Jorge
and Erickson-Ridout, K. Kathryn
and Paik Kim, Jane
and Buttlaire, Stuart
and Ridout, Samuel
and Argue, Stuart
and Tregarthen, Jenna",
title="Effects of a Digital Therapeutic Adjunct to Eating Disorder Treatment on Health Care Service Utilization and Clinical Outcomes: Retrospective Observational Study Using Electronic Health Records",
journal="JMIR Ment Health",
year="2024",
month="Nov",
day="27",
volume="11",
pages="e59145",
keywords="digital therapeutics",
keywords="app-augmented therapy",
keywords="eating disorders",
keywords="health care utilization",
keywords="costs",
keywords="real-world data",
keywords="depression",
keywords="emergency department",
keywords="outpatient care",
keywords="eating",
keywords="treatment",
keywords="therapy",
keywords="retrospective analysis",
keywords="electronic health record",
keywords="patient",
keywords="app",
keywords="outpatient",
abstract="Background: The need for scalable solutions facilitating access to eating disorder (ED) treatment services that are efficient, effective, and inclusive is a major public health priority. Remote access to synchronous and asynchronous support delivered via health apps has shown promise, but results are so far mixed, and there are limited data on whether apps can enhance health care utilization. Objective: This study aims to examine the effects of app-augmented treatment on clinical outcomes and health care utilization for patients receiving treatment for an ED in outpatient and intensive outpatient levels of care. Methods: Recovery Record was implemented in outpatient and intensive outpatient services in a California-based health maintenance organization. We examined outcomes for eligible patients with ED by comparing clinical and service utilization medical record data over a 6-month period after implementation with analogous data for the control group in the year prior. We used a logistic regression model and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias. Results: App-augmented treatment was associated with a significant decrease in emergency department visits (P<.001) and a significant increase in outpatient treatment utilization (P<.001). There was a significantly larger weight gain for patients in low-weight categories (ie, underweight, those with anorexia, or those with severe anorexia) with app-augmented treatment (treatment effect: 0.74, 0.25, and 0.35, respectively; P=.02), with a greater percentage of patients moving into a higher BMI class (P=.01). Conclusions: Integrating remote patient engagement apps into ED treatment plans can have beneficial effects on both clinical outcomes and service utilization. More research should be undertaken on long-term efficacy and cost-effectiveness to further explore the impact of digital health interventions in ED care. ",
doi="10.2196/59145",
url="https://mental.jmir.org/2024/1/e59145"
}


@Article{info:doi/10.2196/53140,
author="Hu, Yaolin
and Wang, Jian
and Zhou, Jianbo
and Gu, Yuanyuan
and Nicholas, Stephen
and Maitland, Elizabeth",
title="Preferences of Individuals With Obesity for Online Medical Consultation in Different Demand Scenarios: Discrete Choice Experiments",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="27",
volume="26",
pages="e53140",
keywords="online medical consultation",
keywords="obesity",
keywords="discrete choice experiments",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: Obesity is a unique chronic disease, with China having the largest number of people living with overweight and obesity in the world. There has been little research from the demand perspective for online medical consultation (OMC) by individuals living with obesity. With the growing demand for obesity OMC, especially due to the emergence of new pharmacotherapies, such as glucagon-like peptide-1 receptor agonists, individuals living with obesity are seeking both advice on obesity management and the prescription of obesity drugs. Therefore, our demand scenarios defined 2 OMC motivations to manage obesity: ``For-Drugs'' use and ``For-Advice'' use. Objective: This study aims to assess and compare the preferences for For-Drugs and For-Advice OMC among individuals living with obesity in China. Methods: Following the International Society for Pharmacoeconomics and Outcomes Research's checklist and comprising 400 participants assigned to the For-Drugs scenario and 400 to the For-Advice scenario, the For-Drugs and For-Advice preferences were estimated through discrete choice experiments. The groups in the 2 scenarios followed a similar distribution, and the 2 different demand scenarios shared the same discrete choice experiment design, comprising 16 choice sets with 6 representative attributes. Mixed logit modeling was used to estimate the willingness to pay and relative importance scores. Results: Doctors with well-known and general expert titles, versus ordinary doctors; doctors from high-level, provincial, tertiary, and municipal hospitals, versus lower-level county hospitals; less waiting time; and lower OMC fees were preferred in both the For-Drugs and For-Advice scenarios. The differences between the 2 scenarios lay in the consultation format, consultation duration, and the relative importance of consultation duration versus waiting time. The For-Advice group preferred telephone consultations, while the For-Drugs group did not; the For-Drugs group preferred longer consultation duration ($\beta$=.029), while the For-Advice group preferred shorter consultation duration ($\beta$=--.030); and the For-Drugs group rated consultation duration higher than waiting time, while the For-Advice group rated the waiting time as more important than consultation duration. Combined with our qualitative research, the differences can be explained by the different consultation needs in the 2 scenarios, where longer patient consultations were preferred by the For-Drugs patients who sought detailed advice on drug side effects, while quick and direct responses were preferred by the For-Advice participants. Conclusions: By revealing user preferences on costs, doctors' titles and hospital level, wait time, and consultation duration and format, our research informs OMC platforms, OMC regulators, and doctors on market segmentation and service differentiation strategies. ",
doi="10.2196/53140",
url="https://www.jmir.org/2024/1/e53140"
}


@Article{info:doi/10.2196/65455,
author="Hu, Lu
and Lin, Nelson?F
and Shi, Yun
and Cao, Jiepin
and Sevick, Ann Mary
and Li, Huilin
and Beasley, M. Jeannette
and Levy, Natalie
and Tamura, Kosuke
and Xu, Xinyi
and Jiang, Yulin
and Ong, Iris
and Yang, Ximin
and Bai, Yujie
and Su, Liwen
and Chan, Wan Sze
and Yi, S. Stella",
title="The Integrating Cultural Aspects Into Diabetes Education (INCLUDE) Study to Prevent Diabetes in Chinese Immigrants: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="19",
volume="13",
pages="e65455",
keywords="mHealth",
keywords="mobile health",
keywords="prediabetes",
keywords="immigrants",
keywords="prevention",
keywords="diabetes",
keywords="INCLUDE",
keywords="T2DM",
keywords="social determinants of health",
abstract="Background: Type 2 diabetes (T2D) contributes to significant morbidity and mortality for Chinese immigrants in the United States, exacerbated by social determinants of health (SDOH) barriers such as language barriers, limited access to healthy foods, and low health literacy. Objective: The goal of the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study is to test a social media--based intervention adapting the Diabetes Prevention Program (DPP) for Chinese immigrants alongside a culturally adapted, community-supported agriculture program. Here, we report the protocol for the INCLUDE study. Methods: INCLUDE is a 3-year randomized controlled trial (n=150). Participants with prediabetes or at risk for T2D are enrolled and randomized into either the control or intervention group (n=75 each). Participants from the intervention group receive 2-3 culturally tailored, in-language DPP videos weekly for 12 weeks, as well as biweekly phone calls from bilingual study staff to review video content, support goal setting, and assess and address SDOH-related barriers such as food insecurity. Intervention participants will also be given produce for 10 weeks as part of the community-supported agriculture program. Weight (primary outcome), self-efficacy, diet, physical activity, and food insecurity (secondary outcomes) are measured at baseline, 3-month, and 6-month intervals. Splined linear mixed models will be used to examine group differences in longitudinal weight and other secondary outcomes. The INCLUDE study was approved by the Institutional Review Board at the NYU Grossman School of Medicine. Results: Recruitment started in May 2023, with the first cohort of 75 participants enrolled and randomized into 2 groups in July 2023. The 3-month and 6-month assessment of the first-year cohort has been completed. We have recruited 75 participants for the second cohort as of July 2024. Conclusions: The INCLUDE study will serve as an innovative model for culturally adapted, multilevel interventions for underserved communities previously unable to access evidence-based diabetes prevention initiatives. Aligning with several national calls for multilevel interventions, the INCLUDE intervention will provide critical data that will inform how researchers and public health professionals address SDOH barriers faced by underserved populations and prevent diabetes. Trial Registration: ClinicalTrials.gov NCT05492916; https://clinicaltrials.gov/study/NCT05492916 International Registered Report Identifier (IRRID): DERR1-10.2196/65455 ",
doi="10.2196/65455",
url="https://www.researchprotocols.org/2024/1/e65455"
}


@Article{info:doi/10.2196/60865,
author="Liu, Jianyi
and Giannone, Alyssa
and Wang, Hailing
and Wetherall, Lucy
and Juarascio, Adrienne",
title="Understanding Patients' Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="18",
volume="8",
pages="e60865",
keywords="bulimia nervosa",
keywords="binge eating",
keywords="digital intervention",
keywords="deterioration prevention",
keywords="eating disorder",
keywords="bulimia",
keywords="digital health",
keywords="deterioration",
keywords="maintenance",
keywords="mHealth",
keywords="mobile health app",
keywords="interviews",
keywords="qualitative",
keywords="user-centered design",
keywords="psychotherapy",
keywords="CBT",
keywords="cognitive behavioral therapy",
keywords="needs",
keywords="preferences",
keywords="mobile phone",
abstract="Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients' interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. ",
doi="10.2196/60865",
url="https://formative.jmir.org/2024/1/e60865"
}


@Article{info:doi/10.2196/55088,
author="Yang, Lin
and Guo, Zhen
and Xu, Xiaowei
and Kang, Hongyu
and Lai, Jianqiang
and Li, Jiao",
title="An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="15",
volume="8",
pages="e55088",
keywords="Chinese food data",
keywords="multimodal knowledge graph",
keywords="online platform",
keywords="population health promotion",
keywords="health promotion",
keywords="nutrients",
keywords="diet",
keywords="pregnant women",
abstract="Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96\% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. ",
doi="10.2196/55088",
url="https://formative.jmir.org/2024/1/e55088"
}


@Article{info:doi/10.2196/51432,
author="Chotwanvirat, Phawinpon
and Prachansuwan, Aree
and Sridonpai, Pimnapanut
and Kriengsinyos, Wantanee",
title="Advancements in Using AI for Dietary Assessment Based on Food Images: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="15",
volume="26",
pages="e51432",
keywords="image-assisted dietary assessment",
keywords="artificial intelligence",
keywords="dietary assessment",
keywords="mobile phone",
keywords="food intake",
keywords="image recognition",
keywords="portion size",
abstract="Background: To accurately capture an individual's food intake, dietitians are often required to ask clients about their food frequencies and portions, and they have to rely on the client's memory, which can be burdensome. While taking food photos alongside food records can alleviate user burden and reduce errors in self-reporting, this method still requires trained staff to translate food photos into dietary intake data. Image-assisted dietary assessment (IADA) is an innovative approach that uses computer algorithms to mimic human performance in estimating dietary information from food images. This field has seen continuous improvement through advancements in computer science, particularly in artificial intelligence (AI). However, the technical nature of this field can make it challenging for those without a technical background to understand it completely. Objective: This review aims to fill the gap by providing a current overview of AI's integration into dietary assessment using food images. The content is organized chronologically and presented in an accessible manner for those unfamiliar with AI terminology. In addition, we discuss the systems' strengths and weaknesses and propose enhancements to improve IADA's accuracy and adoption in the nutrition community. Methods: This scoping review used PubMed and Google Scholar databases to identify relevant studies. The review focused on computational techniques used in IADA, specifically AI models, devices, and sensors, or digital methods for food recognition and food volume estimation published between 2008 and 2021. Results: A total of 522 articles were initially identified. On the basis of a rigorous selection process, 84 (16.1\%) articles were ultimately included in this review. The selected articles reveal that early systems, developed before 2015, relied on handcrafted machine learning algorithms to manage traditional sequential processes, such as segmentation, food identification, portion estimation, and nutrient calculations. Since 2015, these handcrafted algorithms have been largely replaced by deep learning algorithms for handling the same tasks. More recently, the traditional sequential process has been superseded by advanced algorithms, including multitask convolutional neural networks and generative adversarial networks. Most of the systems were validated for macronutrient and energy estimation, while only a few were capable of estimating micronutrients, such as sodium. Notably, significant advancements have been made in the field of IADA, with efforts focused on replicating humanlike performance. Conclusions: This review highlights the progress made by IADA, particularly in the areas of food identification and portion estimation. Advancements in AI techniques have shown great potential to improve the accuracy and efficiency of this field. However, it is crucial to involve dietitians and nutritionists in the development of these systems to ensure they meet the requirements and trust of professionals in the field. ",
doi="10.2196/51432",
url="https://www.jmir.org/2024/1/e51432"
}


@Article{info:doi/10.2196/58363,
author="Oliveira, Ashleigh
and Wolff, John
and Alfouzan, Nouf
and Yu, Jin
and Yahya, Asma
and Lammy, Kayla
and Nakamura, T. Manabu",
title="A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="11",
volume="8",
pages="e58363",
keywords="health application",
keywords="weight loss",
keywords="behavior change technique",
keywords="BCT",
keywords="online weight loss program",
keywords="weight monitoring",
keywords="meal planning",
keywords="sustainable weight loss",
keywords="dietary fiber",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. ",
doi="10.2196/58363",
url="https://formative.jmir.org/2024/1/e58363"
}


@Article{info:doi/10.2196/47104,
author="Wang, Xi
and Wang, Suyuan
and Zhong, Lingyu
and Zhang, Chenghui
and Guo, Yanhong
and Li, Mingxia
and Zhao, Li
and Ji, Shuming
and Pan, Junjie
and Wu, Yunhong",
title="Mobile-Based Platform With a Low-Calorie Dietary Intervention Involving Prepackaged Food for Weight Loss for People With Overweight and Obesity in China: Half-Year Follow-Up Results of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="28",
volume="12",
pages="e47104",
keywords="weight loss",
keywords="obesity",
keywords="body fat",
keywords="food replacement product",
keywords="meal replacement",
keywords="weight",
keywords="obese",
keywords="RCT",
keywords="randomized",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="mobile application",
keywords="mobile phone",
abstract="Background: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. Objective: In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Methods: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups. Results: In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups (P=.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). Conclusions: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900021630; https://www.chictr.org.cn/showproj.html?proj=36183 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-048106 ",
doi="10.2196/47104",
url="https://mhealth.jmir.org/2024/1/e47104"
}


@Article{info:doi/10.2196/51321,
author="Bushey, Erica
and Wu, Yin
and Wright, Alexander
and Pescatello, Linda",
title="The Influence of Physical Activity and Diet Mobile Apps on Cardiovascular Disease Risk Factors: Meta-Review",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="9",
volume="26",
pages="e51321",
keywords="physical activity",
keywords="diet",
keywords="mobile applications",
keywords="obesity",
keywords="hypertension",
keywords="dyslipidemia",
keywords="diabetes",
keywords="mobile phone",
abstract="Background: The literature on whether physical activity (PA) and PA and diet (PA+Diet) mobile apps improve cardiovascular disease (CVD) risk factors is promising. Objective: The aim of this meta-review is to provide an evidence synthesis of systematic reviews and meta-analyses examining the influence of PA and PA+Diet apps on the major CVD risk factors. Methods: We systematically searched 5 databases until January 12, 2022. Included systematic reviews and meta-analyses (1) reported the CVD risk factor outcomes of BMI, waist circumference, body weight, blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose, blood lipids, or PA; (2) enrolled healthy participants ?18 years who may or may not have the metabolic syndrome, diabetes mellitus, or preexisting CVD risk factors; (3) reviewed PA or PA+Diet app interventions integrating behavioral change techniques (BCT) to deliver their information; and (4) had a nonapp control. Results: In total, 17 reviews (9 systematic reviews and 8 meta-analyses) published between 2012 and 2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1 to 24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA app systematic reviews (N=4), the following CVD risk factors improved: body weight and BMI (n=2, 50\%), BP (n=1, 25\%), HbA1c (n=1, 25\%), and blood lipids (n=1, 25\%) decreased, while PA (n=4, 100\%) increased. Of the PA+Diet app systematic reviews (N=5), the following CVD risk factors improved: body weight and BMI (n=3, 60\%), BP (n=1, 20\%), and HbA1c (n=3, 60\%) decreased, while PA (n=3, 60\%) increased. Of the PA app meta-analyses (N=1), the following CVD risk factors improved: body weight decreased (--0.73 kg, 95\% CI --1.45 to --0.01; P=.05) and PA increased by 25 minutes/week (95\% CI 0.58-1.68; P<.001), while BMI (--0.09 kg/m2, 95\% CI --0.29 to 0.10; P=.35) and waist circumference (--1.92 cm, 95\% CI --3.94 to 0.09; P=.06) tended to decrease. Of the PA+Diet app meta-analyses (n=4), the following CVD risk factors improved: body weight (n=4, 100\%; from --1.79 kg 95\% CI --3.17 to --0.41; P=.01 to --2.80 kg 95\% CI --4.54 to --1.06, P=.002), BMI (n=1, 25\%; --0.64 kg/m2, 95\% CI --1.09 to --0.18; P=.01), waist circumference (n=1, 25\%; --2.46 cm, 95\% CI --4.56 to --0.36; P=.02), systolic/diastolic BP (n=1, 25\%; --4.22/--2.87 mm Hg, 95\% CI --6.54 to --1.91/ --4.44 to --1.29; P<.01), and HbA1c (n=1, 25\%; --0.43\%, 95\% CI --0.68 to --0.19; P<.001) decreased. Conclusions: PA and PA+Diet apps appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+Diet apps on CVD risk factors. Trial Registration: PROSPERO CRD42023392359; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=392359 ",
doi="10.2196/51321",
url="https://www.jmir.org/2024/1/e51321",
url="http://www.ncbi.nlm.nih.gov/pubmed/39382958"
}


@Article{info:doi/10.2196/50289,
author="Gansterer, Alina
and Moliterno, Paula
and Neidenbach, Rhoia
and Ollerieth, Caroline
and Czernin, Sarah
and Scharhag, Juergen
and Widhalm, Kurt",
title="Effect of a Web-Based Nutritional and Physical Activity Intervention With Email Support (the EDDY Program) on Primary School Children's BMI Z-Score During the COVID-19 Pandemic: Intervention Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Sep",
day="19",
volume="7",
pages="e50289",
keywords="childhood obesity",
keywords="BMI",
keywords="prevention intervention",
keywords="physical activity",
keywords="nutrition",
keywords="nutritional",
keywords="school-based",
keywords="web-based",
keywords="COVID-19",
keywords="diet",
keywords="child",
keywords="childhood",
keywords="children",
keywords="pediatric",
keywords="pediatrics",
keywords="weight",
keywords="obesity",
keywords="obese",
keywords="exercise",
keywords="school",
keywords="student",
keywords="students",
keywords="youth",
abstract="Background: COVID-19 mitigation measures enhanced increases in children's weight and BMI due to decreased physical activity and increased energy intake. Overweight and obesity were major worldwide problems before the pandemic, and COVID-19 increased their severity even more. High BMI directly correlates with health disadvantages including cardiovascular diseases, musculoskeletal disorders, and mental health diseases. Therefore, it is vitally important to develop counteracting interventions to maintain children's health during exceptional situations like pandemics. However, worldwide data from such interventions are limited, and to our knowledge, no suitable study has been carried out during the pandemic in Austria. Objective: This study was conducted to examine a 15-week web-based intervention with email support, the EDDY (Effect of Sports and Diet Trainings to Prevent Obesity and Secondary Diseases and to Influence Young Children's Lifestyle) program and the effect of nutritional education and physical activity on children's BMI z-score during the COVID-19 pandemic in Vienna, Austria. Methods: The intervention consisted of 3 weekly videos---2 physical activity and 1 nutritional education video, respectively---and a biweekly email newsletter for the parents. This study was conducted in a Viennese primary school from February to June 2021 by a team of physicians, nutritionists, and sports scientists, including both professionals and students. The study population included an intervention group (who received web-based nutritional and physical activity training) and a control group (who received no intervention), comprising in total 125 children aged 8 to 11 years. Due to COVID-19 mitigation measures, the control group was a comparative group observed during the prior school year (2019-2020). Anthropometric measurements were obtained before and after the intervention in both groups. Results: Due to a high dropout rate (n=57, 45.6\%) because of the mitigation measures, there were 41 children in the intervention group and 27 in the control group. At baseline, the BMI z-score was 1.0 (SD 1.1) in the intervention group and 0.6 (SD 1.2) in the control group (P=.17). After the study period, the BMI z-score decreased by 0.06 (SD 0.21) in the intervention group, whereas it increased by 0.17 (SD 0.34) in the control group (P<.001). Comparing the change in BMI z-scores within BMI categories in the intervention group and control group revealed a statistically significant difference in the normal-weight children (P=.006). Further results showed that the decrease in BMI z-score was significant in the intervention group among both boys (P=.004) and girls (P=.01). Conclusions: A web-based intervention with combined nutritional education and physical activity training might be an adequate tool to lessen the enhanced increase in body weight during a pandemic. Therefore, additional studies with greater sample sizes and different locations are needed. As the implementation of such intervention programs is essential, further studies need to be established rapidly. ",
doi="10.2196/50289",
url="https://pediatrics.jmir.org/2024/1/e50289"
}


@Article{info:doi/10.2196/56772,
author="Wall, R. Clare
and Roy, C. Nicole
and Mullaney, A. Jane
and McNabb, Charles Warren
and Gasser, Olivier
and Fraser, Karl
and Altermann, Eric
and Young, Wayne
and Cooney, Janine
and Lawrence, Robyn
and Jiang, Yannan
and Galland, C. Barbara
and Fu, Xiaoxi
and Tonkie, N. Jacqueline
and Mahawar, Nisha
and Lovell, Luisa Amy",
title="Nourishing the Infant Gut Microbiome to Support Immune Health: Protocol of SUN (Seeding Through Feeding) Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="2",
volume="13",
pages="e56772",
keywords="infant",
keywords="complementary feeding",
keywords="gut microbiota",
keywords="immune",
keywords="complementary food",
keywords="feeding",
keywords="gut microbiome",
keywords="microbiome",
keywords="immune system",
keywords="k?mara",
keywords="infancy",
keywords="immune development",
keywords="infant health",
keywords="prevalence",
keywords="respiratory tract infections",
keywords="RTI",
abstract="Background: The introduction of complementary foods during the first year of life influences the diversity of the gut microbiome. How this diversity affects immune development and health is unclear. Objective: This study evaluates the effect of consuming k?mara or k?mara with added banana powder (resistant starch) compared to a reference control at 4 months post randomization on the prevalence of respiratory tract infections and the development of the gut microbiome. Methods: This study is a double-blind, randomized controlled trial of mothers and their 6-month-old infants (up to n=300) who have not yet started solids. Infants are randomized into one of 3 groups: control arm (C), standard k?mara intervention (K), and a k?mara intervention with added banana powder product (K+) to be consumed daily for 4 months until the infant is approximately 10 months old. Infants are matched for sex using stratified randomization. Data are collected at baseline (prior to commencing solid food) and at 2 and 4 months after commencing solid food (at around 8 and 10 months of age). Data and samples collected at each timepoint include weight and length, intervention adherence (months 2 and 4), illness and medication history, dietary intake (months 2 and 4), sleep (diary and actigraphy), maternal dietary intake, breast milk, feces (baseline and 4 months), and blood samples (baseline and 4 months). Results: The trial was approved by the Health and Disability Ethics Committee of the Ministry of Health, New Zealand (reference 20/NTA/9). Recruitment and data collection did not commence until January 2022 due to the COVID-19 pandemic. Data collection and analyses are expected to conclude in January 2024 and early 2025, respectively. Results are to be published in 2024 and 2025. Conclusions: The results of this study will help us understand how the introduction of a specific prebiotic complementary food affects the microbiota and relative abundances of the microbial species, the modulation of immune development, and infant health. It will contribute to the expanding body of research that aims to deepen our understanding of the connections between nutrition, gut microbiota, and early-life postnatal health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000026921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378654 International Registered Report Identifier (IRRID): DERR1-10.2196/56772 ",
doi="10.2196/56772",
url="https://www.researchprotocols.org/2024/1/e56772",
url="http://www.ncbi.nlm.nih.gov/pubmed/39222346"
}


@Article{info:doi/10.2196/58735,
author="Wang, Jian
and Mahe, Jinli
and Huo, Yujia
and Huang, Weiyuan
and Liu, Xinru
and Zhao, Yang
and Huang, Junjie
and Shi, Feng
and Li, Zhihui
and Jiang, Dou
and Li, Yilong
and Perceval, Garon
and Zhao, Lindu
and Zhang, Lin",
title="Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e58735",
keywords="thematic synthesis",
keywords="attrition rate",
keywords="dropout",
keywords="behavior change theory",
keywords="digital dietary intervention",
keywords="digital health",
keywords="mHealth",
keywords="eHealth",
keywords="mobile apps",
keywords="email",
abstract="Background: Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75\%-99\%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. Objective: This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. Methods: We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. Results: Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35\% for control groups, 38\% for intervention groups, and 40\% for observational studies, with high heterogeneity (I{\texttwosuperior}=94\%-99\%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. Conclusions: High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory--guided guidelines for digital dietary interventions. Trial Registration: PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9 ",
doi="10.2196/58735",
url="https://www.jmir.org/2024/1/e58735"
}


@Article{info:doi/10.2196/56611,
author="Jamil, Aini Nor
and Dhanaseelan, Jashwiny
and Buhari, Athirah Nurin",
title="Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Aug",
day="26",
volume="7",
pages="e56611",
keywords="osteoporosis",
keywords="bone health",
keywords="adolescent",
keywords="knowledge",
keywords="calcium",
keywords="physical activity",
keywords="e-book",
keywords="effectiveness",
keywords="educational",
keywords="teens",
keywords="youth",
keywords="bone fragility",
keywords="bone",
keywords="Malaysia",
keywords="online questionnaire",
keywords="sociodemographic",
keywords="calcium intake",
keywords="diet",
keywords="behavior change",
abstract="Background: Improved bone health during adolescence can have lifelong implications, reducing the risk of bone fragility. Objective: This study aims to evaluate the effectiveness of an e-book in increasing knowledge about and promoting healthy practices related to bone health among Malay adolescents in Kuala Lumpur, Malaysia. Methods: A total of 72 adolescents (female: n=51, 71\%; age: mean 15, SD 0.74 y) were recruited from selected secondary schools. The participants answered a pretest web-based questionnaire on sociodemographic data, knowledge about osteoporosis, and physical activity. A video call was conducted to assess dietary calcium intake. Participants were provided with a link to an e-book on bone health and instructed to read it within 2 weeks. Postintervention assessments included those for knowledge, physical activity, dietary calcium intake, and acceptance of the e-book. Results: There was a significant increase in the median knowledge score, which was 40.6\% (IQR 31.3\%-46.9\%) during the pretest and 71.9\% (IQR 53.9\%-81.3\%) during the posttest (P<.001). However, no changes were observed in dietary calcium intake or physical activity levels. Most participants did not meet the recommended calcium requirements (61/62, 98\%) and exhibited sedentary behavior (pretest: 51/62, 82\%; posttest: 48/62, 77\%). The e-book, however, was well accepted, with the majority reporting that they understood the contents (70/72, 97\%), liked the graphics (71/72, 99\%), and approved of the layout (60/72, 83\%) and font size (66/72, 92\%) used. Conclusions: The developed e-book effectively increases knowledge levels related to bone health and is well accepted among participants. However, this educational material did not improve bone health practices. Additional strategies are necessary to bridge the gap between knowledge and behavior change. ",
doi="10.2196/56611",
url="https://pediatrics.jmir.org/2024/1/e56611"
}


@Article{info:doi/10.2196/49589,
author="Ko, Jisook
and Wang, Jing
and Mbue, Ngozi
and Schembre, Susan
and Cron, Stanley",
title="Effect of the Implementation of a Multiple-Behavior Self-Monitoring Intervention on Dietary Intake in Type 2 Diabetes: Secondary Data Analysis",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="20",
volume="8",
pages="e49589",
keywords="electronic diary",
keywords="technology-assisted self-monitoring",
keywords="multiple-behavior intervention",
keywords="type 2 diabetes",
keywords="diabetes",
keywords="self-monitoring",
keywords="monitoring",
keywords="dietary intake",
keywords="monitor",
keywords="carbohydrate intake",
keywords="calories",
keywords="education",
keywords="diabetic",
keywords="e-diary",
keywords="e diary",
keywords="self-care",
abstract="Background: An electronic diary embedded in a mobile device to monitor lifestyle can be as effective as traditional methods. However, the efficacy of self-monitoring multiple behaviors for dietary intake has not been well studied in people with diabetes. Objective: This study aimed to compare the effect of using technology-assisted self-monitoring versus paper diaries on changes in dietary intake. Methods: This is a secondary analysis of data collected from 39 people with type 2 diabetes as part of a 3-month pilot clinical trial. Changes in energy intake and the contribution of total fat intake and total carbohydrate intake to total calories (\%) from baseline to after intervention (3 months) were evaluated. Results: In total, 26 (67\%) of the 39 participants preferred mobile diaries over paper diaries. Participants in the mobile diary group showed slightly higher self-monitoring adherence. Linear mixed modeling results indicated a significant overall decrease in total energy intake (P=.005), dietary fat intake (P=.01), and carbohydrate intake (P=.08) from baseline to 3 months. No significant group differences were detected (P>.05). Conclusions: The implementation of a 3-month, multiple-behavior, self-monitoring intervention in Diabetes Self-Management Education programs has resulted in successful reduction in dietary intake (energy, fat, and carbohydrate), whichever self-monitoring method is chosen by participants according to their preferences. Long-term studies are needed to confirm our findings on dietary intake and examine other behavioral and disease outcomes that require monitoring. ",
doi="10.2196/49589",
url="https://formative.jmir.org/2024/1/e49589"
}


@Article{info:doi/10.2196/57577,
author="Thomas, Carien Pamela
and Curtis, Kristina
and Potts, W. Henry W.
and Bark, Pippa
and Perowne, Rachel
and Rookes, Tasmin
and Rowe, Sarah",
title="Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis",
journal="JMIR Ment Health",
year="2024",
month="Aug",
day="1",
volume="11",
pages="e57577",
keywords="digital health",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="smartphone",
keywords="behavior change",
keywords="behavior change technique",
keywords="systematic review",
keywords="eating disorders",
keywords="disordered eating",
keywords="binge eating",
keywords="bulimia nervosa",
keywords="mobile phone",
abstract="Background: Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. Objective: This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. Methods: A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. Results: Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75\% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88\%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: $\chi$21=9.7; P=.002; I{\texttwosuperior}=89.7\%) within the meta-analysis. No other subgroup analyses had statistically significant results. Conclusions: There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. Trial Registration: PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=410060 ",
doi="10.2196/57577",
url="https://mental.jmir.org/2024/1/e57577"
}


@Article{info:doi/10.2196/57777,
author="B{\"a}lter, Katarina
and King, C. Abby
and Fritz, Johanna
and Tillander, Annika
and Halling Ullberg, Oskar",
title="Sustainable Lifestyle Among Office Workers (the SOFIA Study): Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="31",
volume="13",
pages="e57777",
keywords="diet",
keywords="physical activity",
keywords="work life",
keywords="health promotion",
keywords="climate change",
keywords="sustainable lifestyle",
keywords="citizen science",
keywords="Our Voice",
abstract="Background: Society is facing multiple challenges, including lifestyle- and age-related diseases of major public health relevance, and this is of particular importance when the general population, as well as the workforce, is getting older. In addition, we are facing global climate change due to extensive emissions of greenhouse gases and negative environmental effects. A lifestyle that promotes healthy life choices as well as climate and environmentally friendly decisions is considered a sustainable lifestyle. Objective: This study aims to evaluate if providing information about a sustainable lifestyle encourages individuals to adopt more nutritious dietary habits and increase physical activity, as compared to receiving information solely centered around health-related recommendations for dietary intake and physical activity by the Nordic Nutrition Recommendations and the World Health Organization. Novel features of this study include the use of the workplace as an arena for health promotion, particularly among office workers---a group known to be often sedentary at work and making up 60\% of all employees in Sweden. Methods: The Sustainable?Office?Intervention (SOFIA) study is a 2-arm, participant-blinded, cluster randomized controlled trial that includes a multilevel sustainable lifestyle arm (intervention arm, n=19) and a healthy lifestyle arm (control arm, n=14). The eligibility criteria were being aged 18-65 years and doing office work ?20 hours per week. Both intervention arms are embedded in the theoretically based behavioral change wheel method. The intervention study runs for approximately 8 weeks and contains 6 workshops. The study focuses on individual behavior change as well as environmental and policy features at an organizational level to facilitate or hinder a sustainable lifestyle at work. Through implementing a citizen science methodology within the trial, the participants (citizen scientists) collect data using the Stanford Our Voice Discovery Tool app and are involved in analyzing the data, formulating a list of potential actions to bring about feasible changes in the workplace. Results: Participant recruitment and data collection began in August 2022. As of June 2024, a total of 37 participants have been recruited. The results of the pilot phase are expected to be published in 2024 or 2025. Conclusions: Given the ongoing climate change, negative environmental effects, and the global epidemic of metabolic diseases, a sustainable lifestyle among office workers holds important potential to help in counteracting this trend. Thus, there is an urgent unmet need to test the impact of a sustainable lifestyle on food intake, physical activity, and environmental and climate impacts in a worksite-based randomized controlled trial. This study protocol responds to a societal need by addressing multilevel aspects, including individual behavior changes as well as environmental and organizational changes of importance for the successful implementation of sustainable lifestyle habits in an office setting. International Registered Report Identifier (IRRID): DERR1-10.2196/57777 ",
doi="10.2196/57777",
url="https://www.researchprotocols.org/2024/1/e57777",
url="http://www.ncbi.nlm.nih.gov/pubmed/39083333"
}


@Article{info:doi/10.2196/52779,
author="Polfuss, Michele
and Smith, Kathryn
and Hopson, Betsy
and Moosreiner, Andrea
and Huang, Chiang-Ching
and Ravelli, N. Michele
and Ding, Dan
and Huang, Zijian
and Rocque, G. Brandon
and White-Traut, Rosemary
and Van Speybroeck, Alexander
and Sawin, J. Kathleen",
title="Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="2",
volume="13",
pages="e52779",
keywords="obesity",
keywords="overweight",
keywords="body composition",
keywords="energy expenditure",
keywords="doubly labeled water",
keywords="spina bifida",
keywords="children",
keywords="adolescents",
keywords="wearable device",
abstract="Background: Obesity prevalence in youth with spina bifida is higher than in their typically developing peers. Obesity is associated with lifelong medical, psychological, and economic burdens. Successful prevention or treatment of obesity in individuals with spina bifida is compromised by (1) the lack of valid and reliable methods to identify body fat in a clinical setting and (2) limited data on energy expenditure that are necessary to provide daily caloric recommendations. Objective: The objectives of this study will be to develop 2 algorithms for use in youth with spina bifida in a clinical setting, one to model body fat and one to predict total daily energy expenditure. In addition, physical activity and dietary intake will be described for the sample. Methods: This multisite, prospective, national clinical study will enroll 232 youth with myelomeningocele aged 5 to 18 years (stratified by age and mobility). Participants will be enrolled for 1 week. Data obtained include 4 measures of body composition, up to 5 height measures, a ramped activity protocol, and a nutrition and physical activity screener. Participants will wear an accelerometer for the week. On the final study day, 2 samples of urine or saliva, which complete the doubly labeled water protocol, will be obtained. The analysis will include descriptive statistics, Bland-Altman plots, concordance correlation, and regression analysis. Results: The study received extramural federal funding in July 2019. Data collection was initiated in March 2020. As of April 2024, a total of 143 (female participants: n=76, 53.1\%; male participants: n=67, 46.9\%) out of 232 participants have been enrolled. Data collection is expected to continue throughout 2024. A no-cost extension until November 2025 will be requested for data analysis and dissemination of findings. Conclusions: This study furthers previous pilot work that confirmed the acceptability and feasibility of obtaining alternate height, body composition, and energy expenditure measures. The findings from this study will enhance screening, prevention, and treatment of abnormal weight status by facilitating the accurate identification of youths' weight status category and recommendations of daily caloric needs for this population that is at higher risk of obesity. Furthermore, the findings have the potential to impact outcomes for youth diagnosed with disabilities other than spina bifida who experience similar challenges related to alterations in body composition or fat distribution or measurement challenges secondary to mobility issues or musculoskeletal problems. International Registered Report Identifier (IRRID): DERR1-10.2196/52779 ",
doi="10.2196/52779",
url="https://www.researchprotocols.org/2024/1/e52779"
}


@Article{info:doi/10.2196/57849,
author="So, Hei Jeffrey Tsz
and Nambiar, Smita
and Byrne, Rebecca
and Gallegos, Danielle
and Baxter, A. Kimberley",
title="Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="30",
volume="7",
pages="e57849",
keywords="co-design",
keywords="fathers",
keywords="child nutrition",
keywords="child feeding",
keywords="intervention design",
keywords="digital delivery",
keywords="parenting",
keywords="participatory",
keywords="videoconference",
keywords="communication technology",
abstract="Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation--Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. ",
doi="10.2196/57849",
url="https://pediatrics.jmir.org/2024/1/e57849",
url="http://www.ncbi.nlm.nih.gov/pubmed/38815260"
}


@Article{info:doi/10.2196/52170,
author="Xu, Zidu
and Gu, Yaowen
and Xu, Xiaowei
and Topaz, Maxim
and Guo, Zhen
and Kang, Hongyu
and Sun, Lianglong
and Li, Jiao",
title="Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="30",
volume="8",
pages="e52170",
keywords="knowledge graph",
keywords="personalized food recommendation",
keywords="geriatric nutrition",
keywords="community",
keywords="ubiquitous computing",
abstract="Background: China's older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph--based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. Objective: This study aims to develop a knowledge graph--based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. Methods: We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo's effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. Results: Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35\%) having and 62 (65\%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo's meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults' own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo's ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual's health profile and dietary requirements. Conclusions: ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo's performance in real-world settings, emphasizing the robust management of complex health data. The system's scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults. ",
doi="10.2196/52170",
url="https://formative.jmir.org/2024/1/e52170",
url="http://www.ncbi.nlm.nih.gov/pubmed/38814702"
}


@Article{info:doi/10.2196/59208,
author="Liu, Chunlan
and Zhou, Run
and Shi, Junping",
title="How to Enhance Adherence in Patients with Nonalcoholic Fatty Liver Disease: A Thought-Provoking Issue",
journal="J Med Internet Res",
year="2024",
month="May",
day="14",
volume="26",
pages="e59208",
keywords="NAFLD",
keywords="adherence",
keywords="digital therapeutics",
keywords="lifestyle modification",
keywords="mobile health",
keywords="nonalcoholic fatty liver disease",
keywords="self-management",
keywords="randomized controlled trial",
doi="10.2196/59208",
url="https://www.jmir.org/2024/1/e59208",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743941"
}


@Article{info:doi/10.2196/49168,
author="Morales-Cahuancama, Bladimir
and Verdezoto, Nervo
and Gonzales-Achuy, Elena
and Quispe-Gala, Cinthia
and Bautista-Olortegui, William
and Hinojosa-Mamani, Paul
and Aparco, Pablo Juan",
title="Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="14",
volume="8",
pages="e49168",
keywords="child",
keywords="children",
keywords="schoolchildren",
keywords="youth",
keywords="student",
keywords="students",
keywords="adolescent",
keywords="formative research",
keywords="digital media",
keywords="digital games",
keywords="serious game",
keywords="serious games",
keywords="nutrition",
keywords="obesity",
keywords="obese",
keywords="overweight",
keywords="mHealth",
keywords="caregivers' perspectives",
keywords="perspective",
keywords="perspectives",
keywords="diet",
keywords="healthy eating",
abstract="Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8\% girls). Of the caregivers, 83\% (3267/3937) were mothers, and 56.5\% (2223/3937) had a secondary education. Only 5.2\% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6\%) and mobile internet (1314/3937, 33.4\%). In addition, 95.3\% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3\% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2\% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7\% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9\% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7\%) preferred to use a mobile phone. Only 38.3\% (1509/3937) indicated they preferred a computer. In addition, 47.9\% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7\% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38\% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. ",
doi="10.2196/49168",
url="https://formative.jmir.org/2024/1/e49168",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743472"
}


@Article{info:doi/10.2196/46036,
author="Chew, Jocelyn Han Shi
and Chew, WS Nicholas
and Loong, Ern Shaun Seh
and Lim, Lin Su
and Tam, Wilson Wai San
and Chin, Han Yip
and Chao, M. Ariana
and Dimitriadis, K. Georgios
and Gao, Yujia
and So, Yan Jimmy Bok
and Shabbir, Asim
and Ngiam, Yuan Kee",
title="Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation",
journal="J Med Internet Res",
year="2024",
month="May",
day="7",
volume="26",
pages="e46036",
keywords="artificial intelligence",
keywords="chatbot",
keywords="chatbots",
keywords="weight",
keywords="overweight",
keywords="eating",
keywords="food",
keywords="weight loss",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="self-regulation",
keywords="self-monitoring",
keywords="anxiety",
keywords="depression",
keywords="consideration of future consequences",
keywords="mental health",
keywords="conversational agent",
keywords="conversational agents",
keywords="eating behavior",
keywords="healthy eating",
keywords="food consumption",
keywords="obese",
keywords="obesity",
keywords="diet",
keywords="dietary",
abstract="Background: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses. Objective: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence--assisted weight management app in improving eating behaviors in a Southeast Asian cohort. Methods: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. Results: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean --0.32, SD 1.16; P<.001), snacking habits (mean --0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean --0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1\%) of the 862 meals skipped. Of the 230 participants, 80 (34.8\%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4\% (21/251). Conclusions: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803 ",
doi="10.2196/46036",
url="https://www.jmir.org/2024/1/e46036",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713909"
}


@Article{info:doi/10.2196/53461,
author="Chong, Mun Kar
and Chia, Airu
and Shah Budin, Syahirah Nur
and Poh, Koon Bee
and Jamil, Aini Nor
and Koh, Denise
and Chong, Foong-Fong Mary
and Wong, Eiin Jyh",
title="Accuracy of a Web-Based Time-Use Diary (MEDAL) in Assessing Children's Meal Intakes With Food Photography by Parents as Reference: Instrument Validation Study",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="7",
volume="7",
pages="e53461",
keywords="children",
keywords="dietary intake",
keywords="time-use diary",
keywords="food photography",
keywords="accuracy",
keywords="mobile phone",
abstract="Background: My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children. Objective: This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children's meals taken by their parents as an objective reference. Methods: A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children's reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents. Results: Overall, the match, omission, and intrusion rates were 62\% (IQR 46\%-86\%), 39\% (IQR 16\%-55\%), and 20\% (IQR 6\%-44\%), respectively. Carbohydrate-based items from the food categories ``rice and porridge''; ``breads, spreads, and cereals''; and ``noodles, pasta, and potatoes'' were reported most accurately (total match rates: 68\%-76\%). ``Snack and dessert'' items were omitted most often (omission rate: 54\%). Furthermore, side dishes from ``vegetables and mushrooms,'' ``eggs and tofu,'' ``meat and fish,'' and ``curry'' food groups were often omitted (omission rates: 42\%-46\%). Items from ``milk, cheese, and yogurt''; ``snacks and desserts''; and ``drinks'' food groups intruded most often (intrusion rates: 37\%-46\%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69\% vs 53\%) and lesser omission rates (31\% vs 49\%; P=.03, respectively). Conclusions: In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children. ",
doi="10.2196/53461",
url="https://pediatrics.jmir.org/2024/1/e53461",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713499"
}


@Article{info:doi/10.2196/53442,
author="Henriksen, Berg Hege
and Knudsen, Dines Markus
and Hjart{\aa}ker, Anette
and Blomhoff, Rune
and Carlsen, Hauger Monica",
title="Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food--Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="30",
volume="26",
pages="e53442",
keywords="digital food frequency questionnaire",
keywords="lifestyle assessment tool",
keywords="relative validity",
keywords="physical activity",
keywords="Norwegian food--based dietary guidelines",
keywords="Norway",
keywords="Norwegian",
keywords="food",
keywords="foods",
keywords="diet",
keywords="dietary",
keywords="lifestyle",
keywords="assessment",
keywords="digital questionnaire",
keywords="investigation",
keywords="food intake",
keywords="dietary intake",
keywords="dietary intakes",
keywords="observation",
keywords="monitoring",
keywords="youths",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="cross-sectional study",
abstract="Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73\%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food--based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except ``water'' (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69\% and 88\% of the participants were classified into the same or adjacent quartile for foods and between 71\% and 82\% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in ``moderate to vigorous intensity'' was underestimated with the DIGIKOST-FFQ. However, estimated time in ``moderate to vigorous intensity,'' ``vigorous intensity,'' and ``sedentary time'' showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in ``moderate to vigorous physical activity,'' ``sedentary time,'' and ``sleep.'' ",
doi="10.2196/53442",
url="https://www.jmir.org/2024/1/e53442",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687986"
}


@Article{info:doi/10.2196/48185,
author="Olsen, Christine
and Lungu, Adrian Daniel",
title="Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="30",
volume="8",
pages="e48185",
keywords="app",
keywords="BMI",
keywords="diet",
keywords="exercise",
keywords="health",
keywords="Heia Meg",
keywords="lifestyle change",
keywords="longitudinal",
keywords="mHealth",
keywords="mobile health",
keywords="motivation",
keywords="nutrition",
keywords="obese",
keywords="obesity",
keywords="overweight",
keywords="physical activity",
keywords="smartphone apps",
keywords="weight",
abstract="Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4\% to 18\% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9\%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. ",
doi="10.2196/48185",
url="https://formative.jmir.org/2024/1/e48185",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687565"
}


@Article{info:doi/10.2196/42402,
author="Han, Yunmin
and Sung, Hoyong
and Kim, Geonhui
and Ryu, Yeun
and Yoon, Jiyeon
and Kim, Soo Yeon",
title="Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2024",
month="Apr",
day="18",
volume="8",
pages="e42402",
keywords="weight loss",
keywords="obesity",
keywords="health education",
keywords="self-management",
keywords="health promotion",
keywords="tailored feedback",
keywords="web-based intervention",
keywords="behavior change",
abstract="Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI?23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of --0.74 (SD 1.96) kg (P=.03) and --1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were --1.65 (SD 2.64) kg in the MINE group, --1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group {\texttimes} time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 ",
doi="10.2196/42402",
url="https://cardio.jmir.org/2024/1/e42402",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635975"
}


@Article{info:doi/10.2196/51542,
author="Abdullah, Rifham Shazana
and Wan Mohd Zin, Mona Ruziana
and Azizul, Hayati Nur
and Sulaiman, Suffia Nur
and Khalid, Mustafa Norhayati
and Mohd Salim Mullahi Jahn, Jahn Roshan
and Khalil, Nazrin Muhamad Khairul
and Abu Seman, Norhashimah
and Zainal Abidin, Azlin Nur
and Ali, Azizan
and Tan, Zhuan You
and Omar, Azahadi
and Seman, Zamtira
and Yahya, Abqariyah
and Md Noh, Fairulnizal Mohd",
title="The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="10",
volume="8",
pages="e51542",
keywords="intermittent fasting",
keywords="dry fasting",
keywords="healthy plate",
keywords="obesity",
keywords="overweight",
abstract="Background: Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. Objective: This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. Methods: This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4\%) were allocated to the IFHP group and 86 (48.6\%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Results: Most participants were female (147/177, 83.1\%) and Malay (141/177, 79.7\%). After 3 months, there were significant reductions in weight (difference ?1.68; P<.001), BMI (difference ?0.62; P<.001), body fat percentage (difference ?0.921; P<.001), body fat mass (difference ?1.28; P<.001), and visceral fat area (difference ?4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference ?1.428; P=.003), BMI (difference ?0.522; P=.005), body fat percentage (difference ?1.591; P<.001), body fat mass (difference ?1.501; P<.001), visceral fat area (difference ?7.130; P<.001), waist circumference (difference ?2.304; P=.001), and hip circumference (difference ?1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference ?3.206; P<.001, HP difference ?2.675; P=.004) and hip (IFHP difference ?2.443; P<.001; HP difference ?2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference ?2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). Conclusions: A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. International Registered Report Identifier (IRRID): RR2-10.2196/33801. ",
doi="10.2196/51542",
url="https://formative.jmir.org/2024/1/e51542",
url="http://www.ncbi.nlm.nih.gov/pubmed/38598283"
}


@Article{info:doi/10.2196/56083,
author="Yeshurun, Shlomo
and Cramer, Tomer
and Souroujon, Daniel
and Mor, Merav",
title="The Association of Macronutrient Consumption and BMI to Exhaled Carbon Dioxide in Lumen Users: Retrospective Real-World Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="1",
volume="12",
pages="e56083",
keywords="app",
keywords="applications",
keywords="association",
keywords="BMI",
keywords="body mass index",
keywords="carbohydrate",
keywords="carbon dioxide",
keywords="consumption",
keywords="correlate",
keywords="correlation",
keywords="diet",
keywords="dietary",
keywords="exhalation",
keywords="exhale",
keywords="food",
keywords="Lumen",
keywords="macronutrient",
keywords="meal",
keywords="metabolic flexibility",
keywords="metabolic",
keywords="metabolism",
keywords="mHealth",
keywords="mobile health",
keywords="nutrient",
keywords="nutrition",
keywords="nutritional",
keywords="obese",
keywords="obesity",
keywords="postprandial",
keywords="prandial",
keywords="retrospective",
keywords="weight",
abstract="Background: Metabolic flexibility is the ability of the body to rapidly switch between fuel sources based on their accessibility and metabolic requirements. High metabolic flexibility is associated with improved health outcomes and a reduced risk of several metabolic disorders. Metabolic flexibility can be improved through lifestyle changes, such as increasing physical activity and eating a balanced macronutrient diet. Lumen is a small handheld device that measures metabolic fuel usage through exhaled carbon dioxide (CO2), which allows individuals to monitor their metabolic flexibility and make lifestyle changes to enhance it. Objective: This retrospective study aims to examine the postprandial CO2 response to meals logged by Lumen users and its relationship with macronutrient intake and BMI. Methods: We analyzed deidentified data from?2607 Lumen users who logged their meals and measured their exhaled CO2 before and after those meals between May 1, 2023, and October 18, 2023. A linear mixed model was fitted to test the association between macronutrient consumption, BMI, age, and gender to the postprandial CO2 response, followed by a 2-way ANOVA. Results: The model demonstrated significant associations (P<.001) between CO2 response after meals and both BMI and carbohydrate intake (BMI: $\beta$=--0.112, 95\% CI --0.156 to --0.069; carbohydrates: $\beta$=0.046, 95\% CI 0.034-0.058). In addition, a 2-way ANOVA revealed that higher carbohydrate intake resulted in a higher CO2 response compared to low carbohydrate intake (F2,2569=24.23; P<.001), and users with high BMI showed modest responses to meals compared with low BMI (F2,2569=5.88; P=.003). Conclusions: In this study, we show that Lumen's CO2 response is influenced both by macronutrient consumption and BMI. The results of this study highlight a distinct pattern of reduced metabolic flexibility in users with obesity, indicating the value of Lumen for assessing postprandial metabolic flexibility. ",
doi="10.2196/56083",
url="https://mhealth.jmir.org/2024/1/e56083",
url="http://www.ncbi.nlm.nih.gov/pubmed/38439744"
}


@Article{info:doi/10.2196/53294,
author="Li, Shiyu
and Du, Yan
and Miao, Hongyu
and Sharma, Kumar
and Li, Chengdong
and Yin, Zenong
and Brimhall, Bradley
and Wang, Jing",
title="Understanding Heterogeneity in Individual Responses to Digital Lifestyle Intervention Through Self-Monitoring Adherence Trajectories in Adults With Overweight or Obesity: Secondary Analysis of a 6-Month Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="20",
volume="26",
pages="e53294",
keywords="self-monitoring",
keywords="adherence",
keywords="weight loss",
keywords="digital technology",
keywords="behavior change",
keywords="group-based trajectory modeling",
keywords="precision health",
keywords="mobile phone",
abstract="Background: Achieving clinically significant weight loss through lifestyle interventions for obesity management is challenging for most individuals. Improving intervention effectiveness involves early identification of intervention nonresponders and providing them with timely, tailored interventions. Early and frequent self-monitoring (SM) adherence predicts later weight loss success, making it a potential indicator for identifying nonresponders in the initial phase. Objective: This study aims to identify clinically meaningful participant subgroups based on longitudinal adherence to SM of diet, activity, and weight over 6 months as well as psychological predictors of participant subgroups from a self-determination theory (SDT) perspective. Methods: This was a secondary data analysis of a 6-month digital lifestyle intervention for adults with overweight or obesity. The participants were instructed to perform daily SM on 3 targets: diet, activity, and weight. Data from 50 participants (mean age: 53.0, SD 12.6 y) were analyzed. Group-based multitrajectory modeling was performed to identify subgroups with distinct trajectories of SM adherence across the 3 SM targets. Differences between subgroups were examined for changes in clinical outcomes (ie, body weight, hemoglobin A1c) and SDT constructs (ie, eating-related autonomous motivation and perceived competence for diet) over 6 months using linear mixed models. Results: Two distinct SM trajectory subgroups emerged: the Lower SM group (21/50, 42\%), characterized by all-around low and rapidly declining SM, and the Higher SM group (29/50, 58\%), characterized by moderate and declining diet and weight SM with high activity SM. Since week 2, participants in the Lower SM group exhibited significantly lower levels of diet (P=.003), activity (P=.002), and weight SM (P=.02) compared with the Higher SM group. In terms of clinical outcomes, the Higher SM group achieved a significant reduction in body weight (estimate: ?6.06, SD 0.87 kg; P<.001) and hemoglobin A1c (estimate: ?0.38, SD 0.11\%; P=.02), whereas the Lower SM group exhibited no improvements. For SDT constructs, both groups maintained high levels of autonomous motivation for over 6 months. However, the Lower SM group experienced a significant decline in perceived competence (P=.005) compared with the Higher SM group, which maintained a high level of perceived competence throughout the intervention (P=.09). Conclusions: The presence of the Lower SM group highlights the value of using longitudinal SM adherence trajectories as an intervention response indicator. Future adaptive trials should identify nonresponders within the initial 2 weeks based on their SM adherence and integrate intervention strategies to enhance perceived competence in diet to benefit nonresponders. Trial Registration: ClinicalTrials.gov NCT05071287; https://clinicaltrials.gov/study/NCT05071287 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106845 ",
doi="10.2196/53294",
url="https://www.jmir.org/2024/1/e53294",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506903"
}


@Article{info:doi/10.2196/51108,
author="Delaney, Tessa
and Jackson, Jacklyn
and Lecathelinais, Christophe
and Clinton-McHarg, Tara
and Lamont, Hannah
and Yoong, Lin Sze
and Wolfenden, Luke
and Sutherland, Rachel
and Wyse, Rebecca",
title="Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click \& Crunch High Schools): Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="19",
volume="26",
pages="e51108",
keywords="randomized controlled trial",
keywords="web-based ordering systems",
keywords="ordering",
keywords="menu",
keywords="menus",
keywords="prompt",
keywords="prompts",
keywords="prompting",
keywords="nudge",
keywords="nudges",
keywords="behavior change",
keywords="behaviour change",
keywords="digital intervention",
keywords="lunch",
keywords="school",
keywords="menu labelling",
keywords="behavioral economics",
keywords="secondary school",
keywords="meal delivery apps",
keywords="public health nutrition",
keywords="meal",
keywords="meals",
keywords="nutrition",
keywords="nutritional",
keywords="diet",
keywords="eating",
keywords="food",
keywords="schools",
keywords="student",
keywords="students",
keywords="RCT",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="purchase",
keywords="purchasing",
keywords="canteen",
keywords="canteens",
keywords="choice",
keywords="choices",
keywords="architecture",
abstract="Background: School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems (``online canteens'') are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online. Objective: This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up. Methods: A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either ``everyday,'' ``occasional,'' or ``should not be sold.'' Primary outcomes were the average proportion of ``everyday,'' ``occasional,'' and ``should not be sold'' items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen. Results: From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more ``everyday'' items (+11.5\%, 95\% CI 7.3\% to 15.6\%; P<.001), and significantly fewer ``occasional'' (--5.4\%, 95\% CI --9.4\% to --1.5\%; P=.007) and ``should not be sold'' items (--6\%, 95\% CI --9.1\% to --2.9\%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders. Conclusions: Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students. Trial Registration: Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546?; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/ ",
doi="10.2196/51108",
url="https://www.jmir.org/2024/1/e51108",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502177"
}


@Article{info:doi/10.2196/55193,
author="Edwards, Katie
and Croker, Helen
and Farrow, Claire
and Haycraft, Emma
and Herle, Moritz
and Llewellyn, Clare
and Pickard, Abigail
and Blissett, Jacqueline",
title="Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="19",
volume="13",
pages="e55193",
keywords="ecological momentary assessment",
keywords="avid eating",
keywords="children's eating behavior",
keywords="parental feeding practices",
keywords="feeding behaviour",
keywords="parent",
keywords="children",
keywords="eating behaviour",
keywords="obesity",
keywords="environmental factors",
keywords="observational study",
keywords="feeding",
keywords="United Kingdom",
abstract="Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents' daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children's healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers' daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children's avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 ",
doi="10.2196/55193",
url="https://www.researchprotocols.org/2024/1/e55193",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502178"
}


@Article{info:doi/10.2196/51368,
author="Lee, J. David
and O'Donnell, K. Elizabeth
and Raje, Noopur
and Panaroni, Cristina
and Redd, Robert
and Ligibel, Jennifer
and Sears, D. Dorothy
and Nadeem, Omar
and Ghobrial, M. Irene
and Marinac, R. Catherine",
title="Design and Rationale of Prolonged Nightly Fasting for Multiple Myeloma Prevention (PROFAST): Protocol for a Randomized Controlled Pilot Trial",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="11",
volume="13",
pages="e51368",
keywords="MGUS",
keywords="smoldering myeloma",
keywords="cancer prevention",
keywords="intermittent fasting",
keywords="fasting",
keywords="myeloma",
keywords="cancer",
keywords="oncology",
keywords="oncological",
keywords="overweight",
keywords="weight",
keywords="obese",
keywords="obesity",
keywords="tumor",
keywords="tumors",
keywords="RCT",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="body mass index",
keywords="BMI",
keywords="blood",
keywords="hematology",
keywords="hematological",
keywords="gammopathy",
keywords="eating",
keywords="diet",
keywords="dietary",
abstract="Background: Obesity is an established, modifiable risk factor of multiple myeloma (MM); yet, no lifestyle interventions are routinely recommended for patients with overweight or obesity with MM precursor conditions. Prolonged nightly fasting is a simple, practical dietary regimen supported by research, suggesting that the synchronization of feeding-fasting timing with sleep-wake cycles favorably affects metabolic pathways implicated in MM. We describe the design and rationale of a randomized controlled pilot trial evaluating the efficacy of a regular, prolonged nighttime fasting schedule among individuals with overweight or obesity at high risk for developing MM or a related lymphoid malignancy. Objective: We aim to investigate the effects of 4-month prolonged nightly fasting on body composition and tumor biomarkers among individuals with overweight or obesity with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or smoldering Waldenstr{\"o}m macroglobulinemia (SWM). Methods: Individuals with MGUS, SMM, or SWM aged ?18 years and a BMI of ?25 kg/m2 are randomized to either a 14-hour nighttime fasting intervention or a healthy lifestyle education control group. Participants' baseline diet and lifestyle patterns are characterized through two 24-hour dietary recalls: questionnaires querying demographic, comorbidity, lifestyle, and quality-of-life information; and wrist actigraphy measurements for 7 days. Fasting intervention participants are supported through one-on-one telephone counseling by a health coach and automated SMS text messaging to support fasting goals. Primary end points of body composition, including visceral and subcutaneous fat (by dual-energy x-ray absorptiometry); bone marrow adiposity (by bone marrow histology); and tumor biomarkers, specifically M-proteins and serum free light-chain concentrations (by gel-based and serum free light-chain assays), are assessed at baseline and after the 4-month study period; changes therein from baseline are evaluated using a repeated measures mixed-effects model that accounts for the correlation between baseline and follow-up measures and is generally robust to missing data. Feasibility?is assessed as participant retention (percent dropout in each arm) and percentage of days participants achieved a ?14-hour fast. Results: The PROlonged nightly FASTing (PROFAST) study was funded in June 2022. Participant recruitment commenced in April 2023. As of July 2023, six participants consented to the study. The study is expected to be completed by April 2024, and data analysis and results are expected to be published in the first quarter of 2025. Conclusions: PROFAST serves as an important first step in exploring the premise that prolonged nightly fasting is a strategy to control obesity and obesity-related mechanisms of myelomagenesis. In evaluating the feasibility and impact of prolonged nightly fasting on body composition, bone marrow adipose tissue, and biomarkers of tumor burden, this pilot study may generate hypotheses regarding metabolic mechanisms underlying MM development and ultimately inform clinical and public health strategies for MM prevention. Trial Registration: ClinicalTrials.gov NCT05565638; http://clinicaltrials.gov/ct2/show/NCT05565638 International Registered Report Identifier (IRRID): DERR1-10.2196/51368 ",
doi="10.2196/51368",
url="https://www.researchprotocols.org/2024/1/e51368",
url="http://www.ncbi.nlm.nih.gov/pubmed/38466984"
}


@Article{info:doi/10.2196/54446,
author="Hovadick, Andrade Ana Carolina de
and Cardoso, Augusto Marly",
title="Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="19",
volume="13",
pages="e54446",
keywords="child health",
keywords="Amazon",
keywords="dietary intake",
keywords="mHealth",
keywords="mobile health",
keywords="multimedia messaging service",
keywords="WhatsApp",
abstract="Background: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. Objective: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. Methods: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children's BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. Results: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. Conclusions: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children. Trial Registration: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t International Registered Report Identifier (IRRID): DERR1-10.2196/54446 ",
doi="10.2196/54446",
url="https://www.researchprotocols.org/2024/1/e54446",
url="http://www.ncbi.nlm.nih.gov/pubmed/38373039"
}


@Article{info:doi/10.2196/49839,
author="Kwon, Young Oh
and Lee, Kyung Mi
and Lee, Won Hye
and Kim, Hyerang
and Lee, Seung Jae
and Jang, Yeonsoo",
title="Mobile App--Based Lifestyle Coaching Intervention for Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="15",
volume="26",
pages="e49839",
keywords="lifestyle modification",
keywords="mobile health",
keywords="nonalcoholic fatty liver disease",
keywords="self-management",
keywords="randomized controlled trial",
abstract="Background: Lifestyle modification in patients with nonalcoholic fatty liver disease (NAFLD) is key to improving health outcomes. Mobile health technologies may offer potential effective and efficient health care support to facilitate self-management. Objective: This study aims to develop a lifestyle coaching intervention using a mobile app for patients with NAFLD and evaluate physiological and psychological health outcomes for 6 months. Methods: This study was a randomized controlled trial. The personalized lifestyle coaching intervention using a mobile app was developed through established guidelines and literature reviews. This intervention consisted of information on NAFLD management, diet and physical activity self-monitoring, and coaching sessions based on patient records and SMS text messages. A total of 102 individuals were enrolled in the study and randomly assigned to the intervention group (n=48) or the control group (n=54). The outcomes were improvements in physiological (weight, liver fat score, aspartate aminotransferase, alanine transferase, and gamma-glutamyl transferase) and clinical outcomes (self-management, NAFLD self-management knowledge, self-efficacy, fatigue, depression, and quality of life). Data were analyzed using descriptive analysis and a linear mixed model to test the effects of the intervention. Results: All participants completed the study. The mean age of the participants was 48.9 (SD 13.74) years, 38.2\% (39/102) were female participants, and 65.7\% (67/102) were married. There were no differences in baseline demographic and clinical data between the intervention and control groups. Changes from baseline to 6 months were significant only within the intervention group for weight (P<.001), liver fat score (P=.01), aspartate aminotransferase (P=.03), alanine transferase (P=.002), gamma-glutamyl transferase (P=.04), self-management (P<.001), fatigue (P=.005), depression (P=.003), and quality of life (P<.001). The differences between the 2 groups for the changes over the 6 months were significant in self-management (P=.004), self-management knowledge (P=.04), fatigue (P=.004), depression (P=.04), and quality of life (P=.01). However, the intervention-by-time interaction was significantly effective only for self-management (P=.006) and fatigue (P=.02). Conclusions: Nonpharmacological interventions using a mobile app may be effective in improving the physiological and psychological health outcomes of patients with NAFLD. Trial Registration: Clinical Research Information Service KCT0005549; http://tinyurl.com/y2zb6usy ",
doi="10.2196/49839",
url="https://www.jmir.org/2024/1/e49839",
url="http://www.ncbi.nlm.nih.gov/pubmed/38358794"
}


@Article{info:doi/10.2196/48817,
author="O'Hara, Cathal
and Gibney, R. Eileen",
title="Dietary Intake Assessment Using a Novel, Generic Meal--Based Recall and a 24-Hour Recall: Comparison Study",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="14",
volume="26",
pages="e48817",
keywords="meal patterns",
keywords="eating behaviors",
keywords="eating occasions",
keywords="nutrition assessment",
keywords="dietary intake assessment",
keywords="24-hour recall",
keywords="relative validity",
abstract="Background: Dietary intake assessment is an integral part of addressing suboptimal dietary intakes. Existing food-based methods are time-consuming and burdensome for users to report the individual foods consumed at each meal. However, ease of use is the most important feature for individuals choosing a nutrition or diet app. Intakes of whole meals can be reported in a manner that is less burdensome than reporting individual foods. No study has developed a method of dietary intake assessment where individuals report their dietary intakes as whole meals rather than individual foods. Objective: This study aims to develop a novel, meal-based method of dietary intake assessment and test its ability to estimate nutrient intakes compared with that of a web-based, 24-hour recall (24HR). Methods: Participants completed a web-based, generic meal--based recall. This involved, for each meal type (breakfast, light meal, main meal, snack, and beverage), choosing from a selection of meal images those that most represented their intakes during the previous day. Meal images were based on generic meals from a previous study that were representative of the actual meal intakes in Ireland. Participants also completed a web-based 24HR. Both methods were completed on the same day, 3 hours apart. In a crossover design, participants were randomized in terms of which method they completed first. Then, 2 weeks after the first dietary assessments, participants repeated the process in the reverse order. Estimates of mean daily nutrient intakes and the categorization of individuals according to nutrient-based guidelines (eg, low, adequate, and high) were compared between the 2 methods. P values of less than .05 were considered statistically significant. Results: In total, 161 participants completed the study. For the 23 nutrient variables compared, the median percentage difference between the 2 methods was 7.6\% (IQR 2.6\%-13.2\%), with P values ranging from <.001 to .97, and out of 23 variables, effect sizes for the differences were small for 19 (83\%) variables, moderate for 2 (9\%) variables, and large for 2 (9\%) variables. Correlation coefficients were statistically significant (P<.05) for 18 (78\%) of the 23 variables. Statistically significant correlations ranged from 0.16 to 0.45, with median correlation of 0.32 (IQR 0.25-0.40). When participants were classified according to nutrient-based guidelines, the proportion of individuals who were classified into the same category ranged from 52.8\% (85/161) to 84.5\% (136/161). Conclusions: A generic meal--based method of dietary intake assessment provides estimates of nutrient intake comparable with those provided by a web-based 24HR but with varying levels of agreement among nutrients. Further studies are required to refine and improve the generic recall across a range of nutrients. Future studies will consider user experience including the potential feasibility of incorporating image recognition of whole meals into the generic recall. ",
doi="10.2196/48817",
url="https://www.jmir.org/2024/1/e48817",
url="http://www.ncbi.nlm.nih.gov/pubmed/38354039"
}


@Article{info:doi/10.2196/47181,
author="Locke, Sean
and Osborne, Jenna",
title="Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="14",
volume="8",
pages="e47181",
keywords="mobile health",
keywords="mHealth",
keywords="behavior change",
keywords="stress management",
keywords="intervention",
keywords="pilot study",
keywords="heart rate variability",
keywords="health coaching",
keywords="coach",
keywords="coaching",
keywords="coaches",
keywords="work-related stress",
keywords="stress",
keywords="wellness",
keywords="burnout",
keywords="behavioral intervention",
keywords="work",
keywords="worker",
keywords="workers",
keywords="employee",
keywords="employees",
keywords="occupational health",
keywords="job",
keywords="satisfaction",
keywords="web-based",
keywords="remote",
keywords="corporate",
keywords="web analytics",
keywords="biofeedback",
keywords="survey",
keywords="surveys",
keywords="interview",
keywords="interviews",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
abstract="Background: Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. Objective: This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. Methods: The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2{\texttimes}2{\texttimes}2{\texttimes}2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Results: Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75\% (12/16) participant retention and 67\% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. Conclusions: The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner. ",
doi="10.2196/47181",
url="https://formative.jmir.org/2024/1/e47181",
url="http://www.ncbi.nlm.nih.gov/pubmed/38354036"
}


@Article{info:doi/10.2196/49322,
author="Salas-Groves, Emily
and Alcorn, Michelle
and Childress, Allison
and Galyean, Shannon",
title="The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="13",
volume="8",
pages="e49322",
keywords="older adults",
keywords="culinary medicine",
keywords="protein",
keywords="muscle mass",
keywords="muscle strength",
keywords="physical activity",
keywords="nutrition intervention",
keywords="online",
abstract="Background: The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51\% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. Objective: This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults' muscle strength and mass. Methods: A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group's muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG. Results: No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P?.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95\% CI 5.77-27.97) g higher than that at the prestudy visit. Conclusions: This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed. Trial Registration: ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978 ",
doi="10.2196/49322",
url="https://formative.jmir.org/2024/1/e49322",
url="http://www.ncbi.nlm.nih.gov/pubmed/38349721"
}


@Article{info:doi/10.2196/50196,
author="Ock{\'e}, Marga
and Dinnissen, Simone Ceciel
and van den Bogaard, Coline
and Beukers, Marja
and Drijvers, Jos{\'e}
and Sanderman-Nawijn, Eline
and van Rossum, Caroline
and Toxopeus, Ido",
title="A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="9",
volume="12",
pages="e50196",
keywords="relative validity",
keywords="smartphone food record",
keywords="24-hour dietary recall",
keywords="mobile app",
keywords="national food consumption surveys",
keywords="smartphone",
keywords="food",
keywords="food consumption",
keywords="app",
keywords="diet",
keywords="dietary intake",
keywords="nutrients",
keywords="survey",
keywords="mobile phone",
abstract="Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95\% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3\% men and n=107, 50.7\% women) had plausible recording days. Of all recorded food items, 12.8\% (114/894) were entered via food barcode scanning, and 18.9\% (169/894) were searched at the brand level. For 31\% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10\% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14\% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95\% limits of agreement were 14 kcal (?1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. ",
doi="10.2196/50196",
url="https://mhealth.jmir.org/2024/1/e50196",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335009"
}


@Article{info:doi/10.2196/38891,
author="Gannamani, Rahul
and Castela Forte, Jos{\'e}
and Folkertsma, Pytrik
and Hermans, Sven
and Kumaraswamy, Sridhar
and van Dam, Sipko
and Chavannes, Niels
and van Os, Hendrikus
and Pijl, Hanno
and Wolffenbuttel, R. Bruce H.",
title="A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="8",
volume="8",
pages="e38891",
keywords="lifestyle intervention",
keywords="prevention",
keywords="obesity",
keywords="overweight",
keywords="weight loss",
keywords="digital health",
keywords="intervention",
keywords="weight",
keywords="pilot",
keywords="digital",
keywords="data",
keywords="Fogg Behavior Model",
abstract="Background: Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. Objective: The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. Methods: Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. Results: Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70\%) were classified as overweight and 16 (30\%) had obesity. Mean weight loss of 4.2\% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6\% weight loss on average. Total cholesterol decreased by 10.2\% and low-density lipoprotein cholesterol decreased by 12.9\% on average. Systolic and diastolic blood pressure decreased by 3.5\% and 7.5\%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. Conclusions: Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL. ",
doi="10.2196/38891",
url="https://formative.jmir.org/2024/1/e38891",
url="http://www.ncbi.nlm.nih.gov/pubmed/38329792"
}


@Article{info:doi/10.2196/47102,
author="Lee, Kyoungjin
and Park, Jeongok
and Oh, Geum Eui
and Lee, JuHee
and Park, Chang
and Choi, Deuk Young",
title="Effectiveness of a Nurse-Led Mobile-Based Health Coaching Program for Patients With Prostate Cancer at High Risk of Metabolic Syndrome: Randomized Waitlist Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="1",
volume="12",
pages="e47102",
keywords="nurses",
keywords="prostate neoplasms",
keywords="healthy lifestyle",
keywords="metabolic syndrome",
keywords="exercise",
keywords="diet",
keywords="mobile phone",
abstract="Background: Androgen deprivation therapy (ADT), a standard treatment for prostate cancer (PC), causes many physical side effects. In particular, it causes metabolic changes such as fasting glucose abnormalities or accumulation of body fat, and its continuation can lead to metabolic syndrome (MetS), which is closely related to diabetes and cardiovascular disease. Therefore, it is important to maintain and practice a healthy lifestyle in patients with PC. Objective: This study aims to evaluate the effectiveness of a nurse-led mobile-based program that aims to promote a healthy lifestyle in patients with PC undergoing ADT with MetS risk factors. Methods: This was a single-blind, randomized, waitlist control interventional study. A total of 48 patients were randomly assigned to the experimental and waitlist control groups at the urology cancer clinic of a tertiary general hospital in South Korea. The inclusion criteria were patients who had undergone ADT for >6 months, had at least 1 of the 5 MetS components in the abnormal range, and could access a mobile-based education program. The experimental group attended a 4-week mobile-based program on exercise and diet that included counseling and encouragement to maintain a healthy lifestyle, whereas the control group was placed on a waitlist and received usual care during the follow-up period, followed by the intervention. The primary outcome was a change in the lifestyle score. The secondary outcomes were changes in 5 MetS components, body composition, and health-related quality of life. The outcomes were measured at 6 weeks and 12 weeks after the initiation of the intervention. Each participant was assigned to each group in a sequential order of enrollment in a 4{\texttimes}4 permuted block design randomization table generated in the SAS (SAS Institute) statistical program. A linear mixed model was used for statistical analysis. Results: A total of 24 participants were randomly assigned to each group; however, 2 participants in the experimental group dropped out for personal reasons before starting the intervention. Finally, 46 participants were included in the intention-to-treat analysis. The experimental group showed more positive changes in the healthy lifestyle score ($\beta$=29.23; P?.001), level of each MetS component (fasting blood sugar: $\beta$=?12.0; P=.05 and abdominal circumference: $\beta$=?2.49; P=.049), body composition (body weight: $\beta$=?1.52; P<.001 and BMI: $\beta$=?0.55; P<.001), and the urinary irritative and obstructive domain of health-related quality of life ($\beta$=14.63; P<.001) over time than the waitlist control group. Conclusions: Lifestyle changes through nurse-led education can improve level of each MetS components, body composition, and ADT side effects. Nurses can induce positive changes in patients' lifestyles and improve the self-management of patients starting ADT through this program. Trial Registration: Clinical Research Information Service KCT0006560; http://tinyurl.com/yhvj4vwh ",
doi="10.2196/47102",
url="https://mhealth.jmir.org/2024/1/e47102",
url="http://www.ncbi.nlm.nih.gov/pubmed/38300697"
}


@Article{info:doi/10.2196/47850,
author="van der Heijden, Zo{\"e}
and de Gooijer, Femke
and Camps, Guido
and Lucassen, Desiree
and Feskens, Edith
and Lasschuijt, Marlou
and Brouwer-Brolsma, Elske",
title="User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="1",
volume="8",
pages="e47850",
keywords="diet",
keywords="children",
keywords="dietary assessment",
keywords="recall",
keywords="technological innovation",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. Objective: This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Methods: Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57\% boys and n=6, 43\% girls). Results: Most children were able to complete FoodBear's (11/14, 79\%), myBear's (10/14, 71\%), and FoodCam's (9/14, 64\%) usability tasks, but all children required assistance (14/14, 100\%) and most of the children encountered usability problems (13/14, 93\%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Conclusions: Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children's autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children's dietary assessment and the provision of personalized dietary support. ",
doi="10.2196/47850",
url="https://formative.jmir.org/2024/1/e47850",
url="http://www.ncbi.nlm.nih.gov/pubmed/38300689"
}


@Article{info:doi/10.2196/54253,
author="Huffman, Goodgame Landry
and Lawrence-Sidebottom, Darian
and Beam, Brenna Aislinn
and Parikh, Amit
and Guerra, Rachael
and Roots, Monika
and Huberty, Jennifer",
title="Improvements in Adolescents' Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="31",
volume="8",
pages="e54253",
keywords="behavioral care",
keywords="mental health",
keywords="web-based coaching",
keywords="web-based therapy",
keywords="eating disorders",
keywords="eating",
keywords="anorexia",
keywords="coach",
keywords="coaching",
keywords="pediatric",
keywords="pediatrics",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="digital mental health intervention",
keywords="DMHI",
keywords="collaborative",
keywords="digital health",
abstract="Background: Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. Objective: This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents' disordered eating behaviors. Methods: Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. Results: Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4\% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). Conclusions: Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms. ",
doi="10.2196/54253",
url="https://formative.jmir.org/2024/1/e54253",
url="http://www.ncbi.nlm.nih.gov/pubmed/38294855"
}


@Article{info:doi/10.2196/48313,
author="Mohd Saad, Noraini
and Mohamad, Mariam
and Mat Ruzlin, Nadira Aimi",
title="Web-Based Intervention to Act for Weight Loss in Adults With Type 2 Diabetes With Obesity (Chance2Act): Protocol for a Nonrandomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="31",
volume="13",
pages="e48313",
keywords="readiness to change",
keywords="behavior change",
keywords="diabetes",
keywords="overweight",
keywords="weight reduction",
keywords="eHealth",
keywords="obesity",
abstract="Background: In adults with type 2 diabetes (T2D), weight loss can improve hemoglobin A1c, blood pressure, and triglycerides, and reduce the frequency of medications needed. Unfortunately, a large proportion of these individuals are not ready to initiate weight efforts, making existing obesity management strategies less effective. Many digital health interventions aim at weight loss, but there is still limited evidence on their effectiveness in changing weight loss behavior, especially in adults with T2D. Objective: This study aims to develop and validate ``Chance2Act,'' a new web-based intervention, designed specifically to facilitate behavioral change in adults with T2D with obesity who are not ready to act toward weight loss. Then, the effectiveness of the newly developed intervention will be determined from a nonrandomized controlled trial. Methods: A web-based intervention will be developed based on the Transtheoretical Model targeting adults with T2D with obesity who are not ready to change for weight loss. Phase 1 will involve the development and validation of the web-based health intervention module. In phase 2, a nonrandomized controlled trial will be conducted in 2 government health clinics selected by the investigator. This is an unblinded study with a parallel assignment (ie, intervention vs control [usual care] with an allocation ratio of 1:1). A total of 124 study participants will be recruited, of which 62 participants will receive the Chance2Act intervention in addition to the usual care. The primary outcome is the changes in an individual's readiness from a stage of not being ready to change (precontemplation, contemplation, or preparation stage) to being ready for weight loss (action stage). The secondary outcomes include changes in self-efficacy, decisional balance, family support for weight loss, BMI, waist circumference, and body fat composition. Results: The phase 1 study will reveal the intervention's validity through the Content Validity Index and Face Validity Index, considering it valid if both indices exceed 0.83. The effectiveness of the intervention will be determined in phase 2, where the differences within and between groups will be analyzed in terms of the improvement of stages of change and all secondary outcomes as defined in the methodology. Data analysis for phase 2 will commence in 2024, with the anticipated publication of results in March 2024. Conclusions: If proven effective, the result of the study may give valuable insights into the effective behavioral modification strategies for a web-based intervention targeting adults with T2D with obesity but not yet ready to change for weight loss. This intervention may be replicated or adopted in different settings, focusing on behavioral modification support that patients need. This study offers a deeper understanding of the application of behavior change techniques for a more holistic approach to obesity care in T2D. Trial Registration: ClinicalTrials.gov NCT05736536; https://clinicaltrials.gov/study/NCT05736536 International Registered Report Identifier (IRRID): DERR1-10.2196/48313 ",
doi="10.2196/48313",
url="https://www.researchprotocols.org/2024/1/e48313",
url="http://www.ncbi.nlm.nih.gov/pubmed/38294848"
}


@Article{info:doi/10.2196/52987,
author="Richards, Rebecca
and Wren, Gina
and Whitman, Michael",
title="The Potential of a Digital Weight Management Program to Support Specialist Weight Management Services in the UK National Health Service: Retrospective Analysis",
journal="JMIR Diabetes",
year="2024",
month="Jan",
day="24",
volume="9",
pages="e52987",
keywords="digital health intervention",
keywords="smartphone",
keywords="diabetes management",
keywords="obesity management",
keywords="mobile phone",
keywords="management",
keywords="obesity",
keywords="digital health",
keywords="diabetes",
keywords="weight",
keywords="manage",
keywords="support",
keywords="weight management",
keywords="retrospective analysis",
keywords="treatment",
keywords="type 2 diabetes",
keywords="effectiveness",
keywords="primary care",
keywords="weight loss",
keywords="clinical",
keywords="primary care service",
abstract="Background: Digital weight management interventions (DWMIs) have the potential to support existing specialist weight management services (SWMS) in the National Health Service (NHS) to increase access to treatment for people living with obesity and type 2 diabetes. At present, there is limited real-world evidence and long-term outcomes on the potential effectiveness of DWMIs to support such services. Objective: This study aimed to examine real-world data to evaluate the impact of Second Nature's 12-month DWMI for patients living with obesity with or without type 2 diabetes, referred from NHS primary care services, on sustained weight loss over a 2-year period. Methods: Retrospective data were extracted in August 2023 for participants who participated in the program between January 1, 2017, and January 8, 2021. Eligible participants were adults with a BMI ?35 kg/m2, with or without type 2 diabetes. The primary outcomes were weight change in kilograms and percentage weight change at 2 years. Secondary outcomes were weight loss at 1 year, program engagement, and the proportion of participants who achieved ?5\% and ?10\% weight loss. Differences in weight loss between baseline and the 1- and 2-year follow-up points were compared using paired 2-tailed t tests. Linear regression models were used to examine whether participants' ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or program engagement were associated with weight loss at 1 year or 2 years. Results: A total of 1130 participants with a mean baseline BMI of 46.3 (SD 31.6) kg/m2 were included in the analysis. Of these participants, 65\% (740/1130) were female (mean age 49.9, SD 12.0 years), 18.1\% (205/339) were from Black, Asian, mixed, or other ethnicities, and 78.2\% (884/1130) had type 2 diabetes. A total of 281 (24.9\%) participants recorded weight readings at 2 years from baseline, with a mean weight loss of 13.8 kg (SD 14.2 kg; P<.001) or 11.8\% (SD 10.9\%; P<.001). A total of 204 (18.1\%) participants achieved ?5\% weight loss, and 130 (11.5\%) participants reached ?10\% weight loss. Weight loss did not significantly differ by ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or engagement in the program. Conclusions: The findings suggested that Second Nature's DWMI has the potential to support people living with obesity and type 2 diabetes remotely to achieve clinically significant and sustained weight loss at 2 years from baseline. Further research is needed to compare the intervention to standard care and assess integration with multidisciplinary clinical teams and pharmacotherapy in order to support this study's findings. ",
doi="10.2196/52987",
url="https://diabetes.jmir.org/2024/1/e52987",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265852"
}


@Article{info:doi/10.2196/45854,
author="Piernas, Carmen
and Lee, Charlotte
and Hobson, Alice
and Harmer, Georgina
and Payne Riches, Sarah
and Noreik, Michaela
and Jebb, A. Susan",
title="A Behaviorally Informed Mobile App to Improve the Nutritional Quality of Grocery Shopping (SwapSHOP): Feasibility Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="11",
volume="12",
pages="e45854",
keywords="swaps",
keywords="mobile app",
keywords="supermarket",
keywords="food purchases",
keywords="diet",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Interventions targeting the nutritional quality of grocery shopping have the potential to help improve diet and health outcomes. Objective: This study aims to assess the feasibility and acceptability of receiving advice on healthier food purchases through SwapSHOP, a behaviorally informed smartphone app that allows users to scan barcodes of grocery products from the United Kingdom, providing nutritional information and personalized swap suggestions to encourage healthier purchases. Methods: We randomized adult volunteers in a 6-arm parallel-group controlled feasibility trial. Participants used the SwapSHOP app to record their grocery shopping during a 2-week run-in period and were individually randomized in a 3:1 ratio to either intervention or control arms within 3 strata related to a nutrient of concern of their choice: saturated fat (SFA), sugar, or salt. Participants randomized to the intervention received the SwapSHOP app with a healthier swap function, goal setting, and personalized feedback. Participants in the control group were instructed to use a simpler version of the app to log all their food purchases without receiving any guidance or advice. The primary outcome was the feasibility of progression to a full trial, including app use and follow-up rates at 6 weeks. The secondary outcomes included other feasibility outcomes, process and qualitative measures, and exploratory effectiveness outcomes to assess changes in the nutrient content of the purchased foods. Results: A total of 112 participants were randomized into 3 groups: SFA (n=38 intervention and n=13 control), sugar (n=40 intervention and n=15 control), and salt (n=5 intervention and n=1 control, not analyzed). The 2 progression criteria were met for SFA and sugar: 81\% (30/37) and 87\% (34/39) of intervention participants in the SFA and sugar groups, respectively, used the app to obtain healthier swaps, and 89\% (68/76) of intervention participants and 96\% (23/24) of control participants completed follow-up by scanning all purchases over the follow-up period. The process and qualitative outcomes suggested that the intervention was acceptable and has the potential to influence shopping behaviors. There were reductions of ?0.56 g per 100 g (95\% CI ?1.02 to ?0.19) in SFA and ?1 g per 100 g (95\% CI ?1.97 to ?0.03) in total sugars across all food purchases in the intervention groups. Conclusions: People were willing to use the SwapSHOP app to help reduce sugar and SFA (but not salt) in their grocery shopping. Adherence and follow-up rates suggest that a full trial is feasible. Given the suggestive evidence indicating that the intervention resulted in reductions in sugars and SFA, a definitive trial is necessary to target improvements in health outcomes. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN13022312; https://doi.org/10.1186/ISRCTN13022312 ",
doi="10.2196/45854",
url="https://mhealth.jmir.org/2024/1/e45854",
url="http://www.ncbi.nlm.nih.gov/pubmed/38206671"
}


@Article{info:doi/10.2196/41540,
author="Yau, Amy
and Law, Cherry
and Cornelsen, Laura
and Adams, Jean
and Boyland, Emma
and Burgoine, Thomas
and de Vocht, Frank
and White, Martin
and Cummins, Steven",
title="Association Between Household Online Grocery Delivery Service Use and Food and Drink Purchase Behavior in England: Cross-Sectional Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="19",
volume="9",
pages="e41540",
keywords="food and beverages",
keywords="food preferences",
keywords="supermarkets",
keywords="internet",
keywords="consumer behavior",
keywords="lifestyle",
keywords="diet",
keywords="inequality",
keywords="food purchase",
keywords="sociodemographic factors",
keywords="grocery purchase",
keywords="online grocery",
keywords="online purchase",
keywords="public health",
keywords="online",
keywords="delivery",
keywords="grocery",
abstract="Background: Online grocery delivery services (OGDSs) are a popular way of acquiring food. However, it is unclear whether OGDS use is associated with the healthiness of purchases and whether there are sociodemographic differences in OGDS use. If so, the increased prevalence of OGDS use may have implications for population diet, and differential OGDS use could contribute to diet inequalities. Objective: This study aimed to examine whether OGDS use varies by sociodemographic characteristics and is associated with the amount and types of groceries purchased. Methods: Item-level take-home food and drink purchase data (n=3,233,920 items) from households in London and the North of England were available from the 2019 UK Kantar fast-moving consumer goods panel (N=1911). Purchases were categorized as being bought online or in-store. We used logistic regression to estimate the likelihood of an above-median frequency of OGDS use by sociodemographic characteristics. We used Poisson regression to estimate the differences in energy and nutrients purchased by households that had above- and below-median OGDS use and the proportion of energy purchased from products high in fat, salt, and sugar (HFSS) online versus in-store among households that used both shopping methods (n=665). Results: In total, 668 (35\%) households used OGDSs at least once in 2019. Of the households that used OGDSs, the median use was 5 occasions in 2019. Households were more likely to have above-median use in London versus in the North of England (odds ratio 1.29, 95\% CI 1.01-1.65) and if they had a higher annual household income (odds ratio 1.56, 95\% CI 1.02-2.38 for ?{\textsterling}50,000 [US \$64,000] vs <{\textsterling}20,000 [\$25,600]). Households with above-median OGDS use had a higher weekly mean purchase of energy by 1461 (95\% CI 1448-1474) kcal per person compared with households with below-median OGDS use. For households that used a combination of in-store and online shopping, HFSS products made up a lower proportion (--10.1\%, 95\% CI --12\% to --8.1\%) of energy purchased online compared to in-store. Conclusions: Differences in grocery purchases between households with above- and below-median OGDS use could have positive or negative consequences. The extra energy purchased among households with above-median OGDS use could lead to overconsumption or food waste, which has negative consequences for population and environmental health. Alternatively, this extra energy may be replacing out-of-home purchasing, which tends to be less healthy, and may be beneficial for the population diet. Households made fewer HFSS purchases when shopping online compared to in-store, which may be due to differences in the shopping environment or experience, such as fewer promotions and advertisements when shopping online or not having to transport and carry purchases home. As higher-income households used OGDS more frequently, the implications of this sociodemographic pattern on dietary inequalities must be explored. ",
doi="10.2196/41540",
url="https://publichealth.jmir.org/2023/1/e41540",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113090"
}


@Article{info:doi/10.2196/49097,
author="Montilva-Monsalve, Jonas
and Dimantas, Bruna
and Perski, Olga
and Gutman, Morrison Leslie",
title="Barriers and Enablers to the Adoption of a Healthier Diet Using an App: Qualitative Interview Study With Patients With Type 2 Diabetes Mellitus",
journal="JMIR Diabetes",
year="2023",
month="Dec",
day="19",
volume="8",
pages="e49097",
keywords="behavior change techniques",
keywords="diabetes",
keywords="apps",
keywords="smartphone",
keywords="enablers",
keywords="barriers",
keywords="mobile phone",
abstract="Background: Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits. Objective: The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers. Methods: Two semistructured qualitative interview studies were conducted; the first study took place between June and July 2021, with a sample of 8 patients with recently diagnosed (<12 mo) T2D, whereas the second study was conducted between May and June 2022 and included 15 patients with long-standing (>18 mo) T2D. In both studies, topic guides were informed by the Capability, Opportunity, Motivation, and Behavior model and the Theoretical Domains Framework. Transcripts were analyzed using a combined deductive framework and inductive thematic analysis approach. The Behavior Change Wheel framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups. Results: This study identified similarities and differences between patient groups in terms of enablers and barriers to adopting a healthier diet using the app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, whereas the main barriers were the difficulty in deciding which app features to use and limited cooking skills. By contrast, for patients with long-standing T2D, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to performing the target behavior when using the app. Consequently, BCTs were selected to address key barriers in both groups, such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features, and redesigning the landing page of the app to guide users toward these tutorials. Conclusions: Patients with recently diagnosed and long-standing T2D encountered similar enablers but slightly different barriers when using an app to adopting a healthier diet. Consequently, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments to reduce barriers to performing the target behavior. ",
doi="10.2196/49097",
url="https://diabetes.jmir.org/2023/1/e49097",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113087"
}


@Article{info:doi/10.2196/44993,
author="Mahmoodi Kahriz, Bahram
and Snuggs, Sarah
and Sah, Anumeha
and Clot, Sophie
and Lamport, Daniel
and Forrest, Joseph
and Helme-Guizon, Agnes
and Wilhelm, Marie-Claire
and Caldara, Cindy
and Anin, Valentine Camille
and Vogt, Julia",
title="Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="11",
volume="10",
pages="e44993",
keywords="mobile apps",
keywords="healthy eating and physical activity",
keywords="attitude",
keywords="BMI and self-efficacy",
abstract="Background: Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. Objective: In this study, we aimed to identify consumers' most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers' BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. Methods: A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results: ``Home work out suggestions,'' ``exercise tips,'' and ``progress charts'' were the most preferred app features, whereas ``gift vouchers'' and ``shopping discounts'' were the most preferred rewards. ``Connections with other communication apps'' was the least preferred feature, and ``charitable giving'' was the least preferred reward. Importantly, consumers' positive attitude toward the ``social support and connectedness and mindfulness'' app feature predicted willingness to pay for such an app ($\beta$=.229; P=.004). Differences in consumers' health status, motivational factors, and basic demographics moderated these results and consumers' intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. Conclusions: This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers' health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps. ",
doi="10.2196/44993",
url="https://humanfactors.jmir.org/2023/1/e44993",
url="http://www.ncbi.nlm.nih.gov/pubmed/38079197"
}


@Article{info:doi/10.2196/48271,
author="Mokaya, Moses
and Kyallo, Florence
and Yiga, Peter
and Koole, Lena Janna
and Boedt, Tessy
and Vangoitsenhoven, Roman
and Matthys, Christophe",
title="Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="4",
volume="12",
pages="e48271",
keywords="behavior change techniques",
keywords="Behavior Change Wheel",
keywords="type 2 diabetes",
keywords="low-income populations",
keywords="mHealth",
keywords="mobile health",
keywords="glycemic control",
keywords="adults",
keywords="diabetes",
keywords="Africa",
keywords="mobile phone",
keywords="support care",
keywords="care",
keywords="support",
keywords="behavior",
abstract="Background: The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126\% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective: This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods: The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results: In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions: This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID): RR1-10.2196/48271 ",
doi="10.2196/48271",
url="https://www.researchprotocols.org/2023/1/e48271",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048150"
}


@Article{info:doi/10.2196/40857,
author="Weber, Isaac
and Woolhiser, Emily
and Keime, Noah
and Wasvary, Margaret
and Adelman, J. Madeline
and Sivesind, E. Torunn
and Dellavalle, P. Robert",
title="Clinical Efficacy of Nutritional Supplements in Atopic Dermatitis: Systematic Review",
journal="JMIR Dermatol",
year="2023",
month="Nov",
day="29",
volume="6",
pages="e40857",
keywords="atopic dermatitis",
keywords="eczema",
keywords="nutrition",
keywords="dietary supplement",
keywords="oral supplement",
keywords="vitamin",
keywords="probiotic",
keywords="dermatology",
keywords="over the counter",
abstract="Background: Atopic dermatitis (AD), also known as eczema, is a chronic inflammatory skin condition that presents with symptoms of intense pruritus, dryness, and erythema. Dissatisfaction with first-line therapies for AD, the desire to avoid steroids, and the extreme cost of effective biologics have created a demand for alternative treatment options such as oral vitamins and nutritional supplements. Objective: The purpose of this review was to assess the effectiveness of oral nutritional supplements, pre- and probiotics, and vitamin deficiencies and supplements on AD symptomology and clinical course. Methods: We searched Scopus, PubMed, and MEDLINE (Ovid interface) for English-language articles published between 1993 and 2023. The final search was conducted on June 22, 2023. The search terms comprised the following: ``(Atopic Dermatitis or Atopic Eczema) AND (supplement OR vitamin OR mineral OR micronutrients OR Fish Oil OR Omega Fatty Acid OR Probiotics OR Prebiotics OR apple cider vinegar OR collagen OR herbal OR fiber).'' Results: A total of 18 studies---3 (17\%) evaluating vitamins, 4 (22\%) evaluating herbal medicine compounds, 2 (11\%) evaluating single-ingredient nutritional supplements, and 9 (50\%) evaluating pre- and probiotics---involving 881 patients were included in this review. Conclusions: Overall, there is weak evidence to support any one nutritional supplement intervention for the alleviation of AD symptoms. Multiple trials (4/18, 22\%) showed promise for supplements such as Zemaphyte, kefir, and freeze-dried whey with Cuscuta campestris Yuncker extract. The most evidence was found on the effectiveness of probiotics on the clinical course of AD. Lactiplantibacillus plantarum, Ligilactobacillus salivarius, and Lactobacillus acidophilus specifically showed evidence of efficacy and safety across multiple studies (6/18, 33\%). However, larger, more extensive randomized controlled trials are needed to determine the true effectiveness of these supplements on the broader population. Trial Registration: PROSPERO CRD42023470596; https://tinyurl.com/4a9477u7 ",
doi="10.2196/40857",
url="https://derma.jmir.org/2023/1/e40857",
url="http://www.ncbi.nlm.nih.gov/pubmed/38019566"
}


@Article{info:doi/10.2196/49113,
author="Sampa, Begum Masuda
and Biswas, Topu
and Rahman, Siddikur Md
and Aziz, Abdul Nor Hidayati Binti
and Hossain, Nazmul Md
and Aziz, Ab Nor Azlina",
title="A Machine Learning Web App to Predict Diabetic Blood Glucose Based on a Basic Noninvasive Health Checkup, Sociodemographic Characteristics, and Dietary Information: Case Study",
journal="JMIR Diabetes",
year="2023",
month="Nov",
day="24",
volume="8",
pages="e49113",
keywords="blood glucose prediction",
keywords="boosted decision tree regression model",
keywords="machine learning",
keywords="noncommunicable diseases",
keywords="noninvasive",
abstract="Background: Over the past few decades, diabetes has become a serious public health concern worldwide, particularly in Bangladesh. The advancement of artificial intelligence can be reaped in the prediction of blood glucose levels for better health management. However, the practical validity of machine learning (ML) techniques for predicting health parameters using data from low- and middle-income countries, such as Bangladesh, is very low. Specifically, Bangladesh lacks research using ML techniques to predict blood glucose levels based on basic noninvasive clinical measurements and dietary and sociodemographic information. Objective: To formulate strategies for public health planning and the control of diabetes, this study aimed to develop a personalized ML model that predicts the blood glucose level of urban corporate workers in Bangladesh. Methods: Based on the basic noninvasive health checkup test results, dietary information, and sociodemographic characteristics of 271 employees of the Bangladeshi Grameen Bank complex, 5 well-known ML models, namely, linear regression, boosted decision tree regression, neural network, decision forest regression, and Bayesian linear regression, were used to predict blood glucose levels. Continuous blood glucose data were used in this study to train the model, which then used the trained data to predict new blood glucose values. Results: Boosted decision tree regression demonstrated the greatest predictive performance of all evaluated models (root mean squared error=2.30). This means that, on average, our model's predicted blood glucose level deviated from the actual blood glucose level by around 2.30 mg/dL. The mean blood glucose value of the population studied was 128.02 mg/dL (SD 56.92), indicating a borderline result for the majority of the samples (normal value: 140 mg/dL). This suggests that the individuals should be monitoring their blood glucose levels regularly. Conclusions: This ML-enabled web application for blood glucose prediction helps individuals to self-monitor their health condition. The application was developed with communities in remote areas of low- and middle-income countries, such as Bangladesh, in mind. These areas typically lack health facilities and have an insufficient number of qualified doctors and nurses. The web-based application is a simple, practical, and effective solution that can be adopted by the community. Use of the web application can save money on medical expenses, time, and health management expenses. The created system also aids in achieving the Sustainable Development Goals, particularly in ensuring that everyone in the community enjoys good health and well-being and lowering total morbidity and mortality. ",
doi="10.2196/49113",
url="https://diabetes.jmir.org/2023/1/e49113",
url="http://www.ncbi.nlm.nih.gov/pubmed/37999944"
}


@Article{info:doi/10.2196/47101,
author="Murakami, Kentaro
and Shinozaki, Nana
and Kimoto, Nana
and Onodera, Hiroko
and Oono, Fumi
and McCaffrey, A. Tracy
and Livingstone, E. M. Barbara
and Okuhara, Tsuyoshi
and Matsumoto, Mai
and Katagiri, Ryoko
and Ota, Erika
and Chiba, Tsuyoshi
and Nishida, Yuki
and Sasaki, Satoshi",
title="Web-Based Content on Diet and Nutrition Written in Japanese: Infodemiology Study Based on Google Trends and Google Search",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="16",
volume="7",
pages="e47101",
keywords="diet",
keywords="nutrition",
keywords="information",
keywords="internet",
keywords="web",
keywords="Japanese language",
abstract="Background: The increased availability of content of uncertain integrity obtained through the internet is a major concern. To date, however, there has been no comprehensive scrutiny of the fitness-for-purpose of web-based content on diet and nutrition. Objective: This cross-sectional study aims to describe diet- and nutrition-related web-based content written in Japanese, identified via a systematic extraction strategy using Google Trends and Google Search. Methods: We first identified keywords relevant for extracting web-based content (eg, blogs) on diet and nutrition written in Japanese using Google Trends. This process included identification of 638 seed terms, identification of approximately 1500 pairs of related queries (top) and search terms, the top 10\% of which were extracted to identify 160 relevant pairs of related queries (top) and search terms, and identification of 107 keywords for search. We then extracted relevant web-based content using Google Search. Results: The content (N=1703) examined here was extracted following a search based on 107 keywords. The most common themes included food and beverages (390/1703, 22.9\%), weight management (366/1703, 21.49\%), health benefits (261/1703, 15.33\%), and healthy eating (235/1703, 13.8\%). The main disseminators were information technology companies and mass media (474/1703, 27.83\%), food manufacturers (246/1703, 14.45\%), other (236/1703, 13.86\%), and medical institutions (214/1703, 12.57\%). Less than half of the content (790/1703, 46.39\%) clearly indicated the involvement of editors or writers. More than half of the content (983/1703, 57.72\%) was accompanied by one or more types of advertisement. The proportion of content with any type of citation reference was 40.05\% (682/1703). The themes and disseminators of content were significantly associated with the involvement of editors or writers, accompaniment with advertisement, and citation of reference. In particular, content focusing on weight management was more likely to clearly indicate the involvement of editors or writers (212/366, 57.9\%) and to be accompanied by advertisement (273/366, 74.6\%), but less likely to have references cited (128/366, 35\%). Content from medical institutions was less likely to have citation references (62/214, 29\%). Conclusions: This study highlights concerns regarding the authorship, conflicts of interest (advertising), and the scientific credibility of web-based diet- and nutrition-related information written in Japanese. Nutrition professionals and experts should take these findings seriously because exposure to nutritional information that lacks context or seems contradictory can lead to confusion and backlash among consumers. However, more research is needed to draw firm conclusions about the accuracy and quality of web-based diet- and nutrition-related content and whether similar results can be obtained in other major mass media or social media outlets and even other languages. ",
doi="10.2196/47101",
url="https://formative.jmir.org/2023/1/e47101",
url="http://www.ncbi.nlm.nih.gov/pubmed/37971794"
}


@Article{info:doi/10.2196/50870,
author="Su, Yan
and Wu, Kuan-Ching
and Chien, Shao-Yun
and Naik, Aishwarya
and Zaslavsky, Oleg",
title="A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="15",
volume="7",
pages="e50870",
keywords="frailty",
keywords="healthy eating",
keywords="mobile",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="clinical trial",
keywords="Mediterranean diet",
keywords="metabolic health",
keywords="diet",
keywords="dietary",
keywords="RCT",
keywords="randomized controlled trial",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="frail",
keywords="eating",
keywords="food",
keywords="nutrition",
keywords="adherence",
abstract="Background: Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. Objective: This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, ``Olitor,'' designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. Methods: The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called ``Olitor'' and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. Results: The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR --0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95\% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95\% CI 0.08-2.21). The retention rate was 100\%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. Conclusions: This pilot study revealed the potential of the mobile intervention ``Olitor'' in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. Trial Registration: ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712 ",
doi="10.2196/50870",
url="https://formative.jmir.org/2023/1/e50870",
url="http://www.ncbi.nlm.nih.gov/pubmed/37966877"
}


@Article{info:doi/10.2196/51300,
author="Sun, Haonan
and Zhang, Kai
and Lan, Wei
and Gu, Qiufeng
and Jiang, Guangxiang
and Yang, Xue
and Qin, Wanli
and Han, Dongran",
title="An AI Dietitian for Type 2 Diabetes Mellitus Management Based on Large Language and Image Recognition Models: Preclinical Concept Validation Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="9",
volume="25",
pages="e51300",
keywords="ChatGPT",
keywords="artificial intelligence",
keywords="AI",
keywords="diabetes",
keywords="diabetic",
keywords="nutrition",
keywords="nutritional",
keywords="diet",
keywords="dietary",
keywords="dietician",
keywords="medical nutrition therapy",
keywords="ingredient recognition",
keywords="digital health",
keywords="language model",
keywords="image recognition",
keywords="machine learning",
keywords="deep learning",
keywords="NLP",
keywords="natural language processing",
keywords="meal",
keywords="recommendation",
keywords="meals",
keywords="food",
keywords="GPT 4.0",
abstract="Background: Nutritional management for patients with diabetes in China is a significant challenge due to the low supply of registered clinical dietitians. To address this, an artificial intelligence (AI)--based nutritionist program that uses advanced language and image recognition models was created. This program can identify ingredients from images of a patient's meal and offer nutritional guidance and dietary recommendations. Objective: The primary objective of this study is to evaluate the competence of the models that support this program. Methods: The potential of an AI nutritionist program for patients with type 2 diabetes mellitus (T2DM) was evaluated through a multistep process. First, a survey was conducted among patients with T2DM and endocrinologists to identify knowledge gaps in dietary practices. ChatGPT and GPT 4.0 were then tested through the Chinese Registered Dietitian Examination to assess their proficiency in providing evidence-based dietary advice. ChatGPT's responses to common questions about medical nutrition therapy were compared with expert responses by professional dietitians to evaluate its proficiency. The model's food recommendations were scrutinized for consistency with expert advice. A deep learning--based image recognition model was developed for food identification at the ingredient level, and its performance was compared with existing models. Finally, a user-friendly app was developed, integrating the capabilities of language and image recognition models to potentially improve care for patients with T2DM. Results: Most patients (182/206, 88.4\%) demanded more immediate and comprehensive nutritional management and education. Both ChatGPT and GPT 4.0 passed the Chinese Registered Dietitian examination. ChatGPT's food recommendations were mainly in line with best practices, except for certain foods like root vegetables and dry beans. Professional dietitians' reviews of ChatGPT's responses to common questions were largely positive, with 162 out of 168 providing favorable reviews. The multilabel image recognition model evaluation showed that the Dino V2 model achieved an average F1 score of 0.825, indicating high accuracy in recognizing ingredients. Conclusions: The model evaluations were promising. The AI-based nutritionist program is now ready for a supervised pilot study. ",
doi="10.2196/51300",
url="https://www.jmir.org/2023/1/e51300",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943581"
}


@Article{info:doi/10.2196/50714,
author="Bond, S. Dale
and Papasavas, K. Pavlos
and Raynor, A. Hollie
and Grilo, M. Carlos
and Steele, R. Vaughn",
title="Transcranial Magnetic Stimulation for Reducing the Relative Reinforcing Value of Food in Adult Patients With Obesity Pursuing Metabolic and Bariatric Surgery: Protocol for a Pilot, Within-Participants, Sham-Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="6",
volume="12",
pages="e50714",
keywords="obesity",
keywords="repetitive transcranial magnetic stimulation",
keywords="food reinforcement",
keywords="hedonic hunger",
keywords="electroencephalography",
keywords="metabolic and bariatric surgery",
abstract="Background: Metabolic and bariatric surgery (MBS) is the most effective and durable obesity treatment. However, there is heterogeneity in weight outcomes, which is partially attributed to variability in appetite and eating regulation. Patients with a strong desire to eat in response to the reward of palatable foods are more likely to overeat and experience suboptimal outcomes. This subgroup, classified as at risk, may benefit from repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique that shows promise for reducing cravings and consumption of addictive drugs and food; no study has evaluated how rTMS affects the reinforcing value of food and brain reward processing in the context of MBS. Objective: The goal of the Transcranial Magnetic Stimulation to Reduce the Relative Reinforcing Value of Food (RESTRAIN) study is to perform an initial rTMS test on the relative reinforcing value (RRV) of food (the reinforcing value of palatable food compared with money) among adult patients who are pursuing MBS and report high food reinforcement. Using a within-participants sham-controlled crossover design, we will compare the active and sham rTMS conditions on pre- to posttest changes in the RRV of food (primary objective) and the neural modulation of reward, measured via electroencephalography (EEG; secondary objective). We hypothesize that participants will show larger decreases in food reinforcement and increases in brain reward processing after active versus sham rTMS. Methods: Participants (n=10) will attend 2 study sessions separated by a washout period. They will be randomized to active rTMS on 1 day and sham rTMS on the other day using a counterbalanced schedule. For both sessions, participants will arrive fasted in the morning and consume a standardized breakfast before being assessed on the RRV of food and reward tasks via EEG before and after rTMS of the left dorsolateral prefrontal cortex. Results: Recruitment and data collection began in December 2022. As of October 2023, overall, 52 patients have been screened; 36 (69\%) screened eligible, and 17 (47\%) were enrolled. Of these 17 patients, 3 (18\%) were excluded before rTMS, 5 (29\%) withdrew, 4 (24\%) are in the process of completing the protocol, and 5 (29\%) completed the protocol. Conclusions: The RESTRAIN study is the first to test whether rTMS can target neural reward circuits to reduce behavioral (RRV) and neural (EEG) measures of food reward in patients who are pursuing MBS. If successful, the results would provide a rationale for a fully powered trial to examine whether rTMS-related changes in food reinforcement translate into healthier eating patterns and improved MBS outcomes. If the results do not support our hypotheses, we will continue this line of research to evaluate whether additional rTMS sessions and pulses as well as different stimulation locations produce clinically meaningful changes in food reinforcement. Trial Registration: ClinicalTrials.gov NCT05522803; https://clinicaltrials.gov/study/NCT05522803 International Registered Report Identifier (IRRID): DERR1-10.2196/50714 ",
doi="10.2196/50714",
url="https://www.researchprotocols.org/2023/1/e50714",
url="http://www.ncbi.nlm.nih.gov/pubmed/37930756"
}


@Article{info:doi/10.2196/52199,
author="Robbins, N. Ronna
and Cortes, Tiffany
and O'Connor, C. Jason
and Jiwani, Rozmin
and Serra, C. Monica",
title="The Influence of Branched-Chain Amino Acid Supplementation on Fatigue and Tryptophan Metabolism After Acute and Chronic Exercise in Older Adults: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="1",
volume="12",
pages="e52199",
keywords="branched-chain amino acids",
keywords="kynurenine",
keywords="fatigue",
keywords="older adults",
keywords="exercise",
abstract="Background: Fatigue is a strong predictor of negative health outcomes in older adults. Kynurenine, a metabolite of tryptophan, is strongly associated with fatigue. Reductions in fatigue are observed with exercise; however, exercise training does not completely alleviate symptoms. Branched-chain amino acids (BCAAs) have been shown to have advantageous effects on exercise performance and compete with kynurenine for transport into the central nervous system. Thus, the combination of BCAA and exercise may exert synergized effects of mental and physical fatigue. Therefore, we hypothesize that BCAA added to exercise will shift kynurenine metabolism toward enhanced synthesis of kynurenic acid, thereby reducing fatigue. Objective: This randomized, double-blind, placebo-controlled trial aims to compare the effects of acute (approximately 45 min) and chronic (8 wk) exercise with and without BCAA supplementation on mental and physical fatigue and assess whether the hypothesized outcomes are modulated by changes in kynurenine metabolism in 30 older adults (n=15, 50\% per group). Methods: Older adults (aged 60-80 y) who do not exercise >2 days per week and self-report fatigue (?3 on a scale of 1-10) will be recruited. Participants will be randomized to either the exercise+BCAA group or exercise+placebo group. Participants will engage in high-volume, moderate-intensity, whole-body exercise training (aerobic and resistance exercise; either in-person or web-based sessions) 3 times per week for 8 weeks. In addition, participants will consume daily either 100 mg/kg body weight of BCAA (2:1:1 leucine:isoleucine:valine) or placebo (maltodextrin) throughout the 8-week intervention. BCAA and placebo powders will be identical in color and dissolved in 400 mL of water and 2.5 g of a calorie-free water flavor enhancer. Muscle biopsies will be collected before and after the intervention after a 12-hour fast to examine changes in the biomarkers of tryptophan metabolism and inflammation. Our primary outcomes include changes in mental and physical fatigue and metabolism after the 8-week exercise training between the 2 groups. Mental and physical fatigue will be measured before and after the intervention. Mental fatigue will be subjectively assessed through the completion of validated questionnaires. Physical fatigue will be measured by isometric handgrip, 1-repetition maximum, chair rise, 400-meter walk, and cardiopulmonary exercise tests. Results: The study was funded in March 2022, with an anticipated projected data collection period lasting from January 2023 through December 2023. Conclusions: The discovery that kynurenine concentrations are associated with fatigue and are responsive to BCAA supplementation during exercise training could have important implications for the development of future interventions, both lifestyle and pharmacologic, to treat fatigue in older adults. Trial Registration: ClinicalTrials.gov NCT05484661; https://www.clinicaltrials.gov/study/NCT05484661 International Registered Report Identifier (IRRID): DERR1-10.2196/52199 ",
doi="10.2196/52199",
url="https://www.researchprotocols.org/2023/1/e52199",
url="http://www.ncbi.nlm.nih.gov/pubmed/37910166"
}


@Article{info:doi/10.2196/43843,
author="Bucher Della Torre, Sophie
and Lages, Marlene
and Dias, S. Sara
and Guarino, P. Maria
and Braga-Pontes, C{\'a}tia",
title="Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study",
journal="JMIR Serious Games",
year="2023",
month="Oct",
day="3",
volume="11",
pages="e43843",
keywords="vegetable",
keywords="food preference",
keywords="serious games",
keywords="video game",
keywords="children",
keywords="child",
keywords="pediatric",
keywords="obesity prevention",
keywords="pilot study",
keywords="gaming",
keywords="educational game",
keywords="nutrition",
keywords="diet",
keywords="healthy eating",
keywords="food consumption",
keywords="food intake",
abstract="Background: Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake. Objective: This pilot study aimed first to translate the digital game ``Veggies4myHeart'' into French and to assess its influence on young children's preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms. Methods: During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview. Results: A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children's declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44\%), 30 (73\%), 16 (39\%), 29 (71\%), and 26 (63\%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51\%), 36 (80\%), 24 (53\%), 33 (73\%), and 29 (64\%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools. Conclusions: In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake. ",
doi="10.2196/43843",
url="https://games.jmir.org/2023/1/e43843",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788064"
}


@Article{info:doi/10.2196/46310,
author="Sun, Shufang
and Nardi, William
and Murphy, Matthew
and Scott, Ty
and Saadeh, Frances
and Roy, Alexandra
and Brewer, Judson",
title="Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="26",
volume="25",
pages="e46310",
keywords="mobile health",
keywords="mindfulness",
keywords="obesity",
keywords="sexual minority women",
keywords="early life adversity",
keywords="cell phone",
keywords="mobile phone",
abstract="Background: Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity. Objective: This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ?25 kg/m2) to improve health outcomes. Methods: The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews. Results: We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86\% (26/30) and 80\% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66\%) completed all intervention modules, 25 (83\%) were retained at the 2-month follow-up, and 20 (66\%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language. Conclusions: This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women. ",
doi="10.2196/46310",
url="https://www.jmir.org/2023/1/e46310",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751273"
}


@Article{info:doi/10.2196/33810,
author="Krasuska, Marta
and Davidson, M. Emma
and Beune, Erik
and Jenum, Karen Anne
and Gill, MR Jason
and Stronks, Karien
and van Valkengoed, GM Irene
and Diaz, Esperanza
and Sheikh, Aziz",
title="A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="15",
volume="7",
pages="e33810",
keywords="diabetes",
keywords="diet",
keywords="ethnic minority populations",
keywords="Pakistani",
keywords="physical activity",
keywords="prevention",
keywords="South Asian",
keywords="text messages",
keywords="women",
keywords="women's health",
keywords="health intervention",
keywords="digital health",
keywords="mobile health",
keywords="minority",
keywords="exercise",
keywords="text message",
keywords="text messaging",
keywords="SMS",
keywords="development",
keywords="formative",
keywords="diabetes mellitus",
abstract="Background: Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. Objective: We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. Methods: We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). Results: In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide ``friendly encouragement,'' ``companionship,'' and a ``focus on the individual'' and also for the text messages to ``set achievable goals'' and include ``information on cooking healthy meals.'' We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. Conclusions: We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message--based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland. ",
doi="10.2196/33810",
url="https://formative.jmir.org/2023/1/e33810",
url="http://www.ncbi.nlm.nih.gov/pubmed/37713245"
}


@Article{info:doi/10.2196/44955,
author="Pagoto, Sherry
and Xu, Ran
and Bullard, Tiffany
and Foster, D. Gary
and Bannor, Richard
and Arcangel, Kaylei
and DiVito, Joseph
and Schroeder, Matthew
and Cardel, I. Michelle",
title="An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="29",
volume="25",
pages="e44955",
keywords="weight loss",
keywords="digital behavioral weight management program",
keywords="single-arm behavioral trial",
keywords="personalized weight loss program",
keywords="ZeroPoint foods",
keywords="weight management",
keywords="digital intervention",
keywords="diet management",
keywords="exercise",
abstract="Background: Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. Objective: In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ?300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. Methods: We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. Results: Of the 153 participants, 107 (69.9\%) were female, and 65 (42.5\%) identified as being from a minoritized racial or ethnic group. Participants' mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of ?4.25\% (SD 3.93\%) from baseline to 3 months and ?5.05\% (SD 5.59\%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ?3\%, ?5\%, and ?10\% weight loss were 63.4\% (97/153), 51\% (78/153), and 14.4\% (22/153), respectively. The mean percentage of weeks in which participants engaged in ?1 aspects of the program was 87.53\% (SD 23.40\%) at 3 months and 77.67\% (SD 28.69\%) at 6 months. Retention was high (132/153, 86.3\%), and more than two-thirds (94/140, 67.1\%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). Conclusions: This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51\%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability. ",
doi="10.2196/44955",
url="https://www.jmir.org/2023/1/e44955",
url="http://www.ncbi.nlm.nih.gov/pubmed/37642986"
}


@Article{info:doi/10.2196/44150,
author="Akahane, Manabu
and Kanagawa, Yoshiyuki
and Takahata, Yoshihisa
and Nakanishi, Yasuhiro
and Akahane, Takemi
and Imamura, Tomoaki",
title="Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="24",
volume="7",
pages="e44150",
keywords="food defense",
keywords="health hazards",
keywords="intentional contamination",
keywords="foreign substances",
keywords="food delivery service",
abstract="Background: Various stages of the food chain, from production to processing to distribution, can impact food safety. The concept of ``food defense'' has emerged as a countermeasure against intentional contamination of food with foreign substances. Although knowledge of food hygiene is common among consumers, there are currently no reports of consumer surveys on food defense. Objective: This study aims to investigate consumer awareness of food defense and food safety. We analyzed the results focusing on how consumers behave when they find abnormalities in food to further our knowledge on promoting food defense measures. Methods: Participants completed a web-based questionnaire that included items related to awareness of food safety and food defense, as well as actions to be taken in cases of food abnormalities, such as contamination by foreign substances, the presence of a bad smell in purchased food, and the inclusion of extra items not selected by the individual. The participants were asked to indicate their preference among the 5 suggested actions in each case using a 6-point Likert scale. Data analysis involved aggregating responses into binary values. Stepwise linear regression analysis was conducted to examine the relationship between selected actions and questionnaire items, such as sex, age, and personality. Results: A total of 1442 respondents completed the survey, and the majority of participants placed importance on food safety when making food purchases. The recognition of each term was as follows: 95.2\% (n=1373) for ``food security and safety,'' 95.6\% (n=1379) for ``food hygiene,'' and 17.1\% (n=247) for ``food defense.'' The percentages of those who answered that they would ``eat without worrying'' in the case of ``contamination by foreign substances,'' ``bad smell,'' or ``including unpurchased product'' in the frozen food they purchased were 9.1\% (n=131), 4.8\% (n=69), and 30.7\% (n=443), respectively. The results showed that contacting the manufacturer was the most common action when faced with contaminated food or food with a bad smell. Interestingly, a significant percentage of respondents indicated they would upload the issue on social networking sites. Logistic regression analysis revealed that male participants and the younger generation were more likely to choose the option of eating contaminated food without worrying. Additionally, the tendency to upload the issue on social networking sites was higher among respondents who were sociable and brand-conscious. Conclusions: The findings of this study indicate that if food intentionally contaminated with a foreign substance is sold and delivered to consumers, it is possible consumers may eat it and experience health problems. Therefore, it is crucial for not only food manufacturers but also food delivery service providers to consider food defense measures such as protecting food from intentional contamination. Additionally, promoting consumer education and awareness regarding food defense can contribute to enhancing food safety throughout the food chain. ",
doi="10.2196/44150",
url="https://formative.jmir.org/2023/1/e44150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616047"
}


@Article{info:doi/10.2196/45374,
author="Inchusri, Tharoj
and Surangsrirat, Decho
and Kwanmuang, Papichaya
and Poomivanichakij, Prapasiri
and Apiwatgaroon, Ponnapat
and Ongprakobkul, Surathep
and Kongchu, Apissara
and Klinpikul, Anda
and Taneeheng, Ammarin
and Pruphetkaew, Nannapat
and Thongseiratch, Therdpong
and Ngamchaliew, Pitchayanont
and Vichitkunakorn, Polathep",
title="Association of Generation and Group Size With the Usage of a Mobile Health App in Thailand: Secondary Analysis of the ThaiSook Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="17",
volume="25",
pages="e45374",
keywords="application",
keywords="cohort",
keywords="generation group size",
keywords="health care personnel",
keywords="logging function",
keywords="mobile health technology",
keywords="Thailand",
abstract="Background: In Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU){\texttimes}ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. Objective: This study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU{\texttimes}ThaiSook Healthier Challenge. Methods: We conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80\% of the participation period (?23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80\% of the participation period. Results: Of the 827 participants, most were female (734/827, 88.8\%), belonged to a medium-sized group of 6-10 members (479/827, 57.9\%), and belonged to generation Y (377/761, 49.5\%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95\% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95\% CI 1.31-4.92; generation X AOR 1.96, 95\% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95\% CI 1.58-5.16; medium groups AOR 2.06, 95\% CI 1.47-2.88). Water logging was most used (806/827, 97.5\% participants), followed by food, sleep, and workout logging. Conclusions: The MED PSU{\texttimes}ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P<.05). Older generations and larger groups engaged with the app more consistently than younger generations and smaller groups and individuals. ",
doi="10.2196/45374",
url="https://www.jmir.org/2023/1/e45374",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590057"
}


@Article{info:doi/10.2196/41774,
author="Pigat, Sandrine
and Soshina, Mariya
and Berezhnaya, Yulia
and Kryzhanovskaya, Ekaterina",
title="Web-Based 24-Hour Dietary Recall Tool for Russian Adults and School-Aged Children: Validation Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="16",
volume="7",
pages="e41774",
keywords="dietary assessment",
keywords="24-hour dietary recall",
keywords="extent of agreement",
keywords="energy and nutrient intake",
keywords="Russian diet",
keywords="interviewer-administered",
keywords="web-based self-administered",
keywords="diet",
keywords="food intake",
keywords="dietary recall",
keywords="energy intake",
keywords="nutrient intake",
abstract="Background: Data on dietary intakes in Russian adults and children are assessed very infrequently primarily due to the time, cost, and burden to the participants for assessing dietary patterns. To overcome some of those challenges, the use of web-based 24-hour recall methods can be successfully used. Objective: The study objective is to assess the extent of agreement between a self-administered and an interviewer-administered 24-hour dietary recall in Russian adults and school-aged children using an adaptation of a web-based 24-hour recall tool. Methods: This web-based dietary assessment tool is based on a previously validated tool, which has been adapted to the Russian diet and language. A randomized 50\% (n=97) of 194 participants initially completed a self-administered web-based dietary recall, followed by an interviewer-administered 24-hour dietary recall later that same day, and vice versa for the other 50\% (n=97) of participants. Following at least 1 week wash-out period, during visit 2, participant groups completed the 2 dietary recalls in the opposite order. Statistical analysis was carried out on the intake results from both methods for the 2 recalls. Finally, an evaluation questionnaire on ease-of-use of the tool was also completed. Results: In total, intakes of 28 nutrients and energy were analyzed in this study. The Bland-Altman analysis showed that between 98.4\% and 90.5\% of data points were within the limits of agreement among all age groups and nutrients analyzed. A ``moderate to excellent'' reliability between the 2 methods was observed in younger children. In older children, a ``moderate to good'' reliability was observed, with the exception of sodium. In adults, ``moderate to excellent'' reliability between both methods was observed with the exception of vitamins B1, B2, and B6, and pantothenic acid. The level of agreement between the categorization of estimates into thirds of the intake distribution for the average of the 2 days was satisfactory, since the percentages of participants categorized into the same tertile of intake were ?50\%, and the percentages of participants categorized into the opposite tertile of intake were <10\%. The majority of respondents were very positive in their evaluation of the web-based dietary assessment tool. Conclusions: Overall, the web-based dietary assessment tool performs well when compared with a face-to-face, interviewer-administered 24-hour dietary recall and provides comparable estimates of energy and nutrient intakes in Russian adults and children. Trial Registration: ClinicalTrials.gov NCT04372160; https://clinicaltrials.gov/ct2/show/NCT04372160 ",
doi="10.2196/41774",
url="https://formative.jmir.org/2023/1/e41774",
url="http://www.ncbi.nlm.nih.gov/pubmed/37585243"
}


@Article{info:doi/10.2196/46034,
author="Jospe, R. Michelle
and Marano, M. Kari
and Bedoya, R. Arianna
and Behrens, L. Nick
and Cigan, Lacey
and Villegas, Vanessa
and Magee, F. Michelle
and Marrero, G. David
and Richardson, M. Kelli
and Liao, Yue
and Schembre, M. Susan",
title="Exploring the Impact of Dawn Phenomenon on Glucose-Guided Eating Thresholds in Individuals With Type 2 Diabetes Using Continuous Glucose Monitoring: Observational Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="11",
volume="7",
pages="e46034",
keywords="glucose-guided eating",
keywords="dawn phenomenon",
keywords="eating timing",
keywords="eating behavior",
keywords="type 2 diabetes",
keywords="appetite regulation",
keywords="blood glucose self-monitoring",
keywords="food intake regulation",
keywords="glycemic control",
keywords="continuous glucose monitoring",
keywords="glucose",
keywords="appetite",
keywords="diabetes",
keywords="diabetic",
keywords="type 2",
keywords="monitoring",
keywords="blood sugar",
keywords="mobile phone",
abstract="Background: Glucose-guided eating (GGE) improves metabolic markers of chronic disease risk, including insulin resistance, in adults without diabetes. GGE is a timed eating paradigm that relies on experiencing feelings of hunger and having a preprandial glucose level below a personalized threshold computed from 2 consecutive morning fasting glucose levels. The dawn phenomenon (DP), which results in elevated morning preprandial glucose levels, could cause typically derived GGE thresholds to be unacceptable or ineffective among people with type 2 diabetes (T2DM). Objective: The aim of this study is to quantify the incidence and day-to-day variability in the magnitude of DP and examine its effect on morning preprandial glucose levels as a preliminary test of the feasibility of GGE in adults with T2DM. Methods: Study participants wore a single-blinded Dexcom G6 Pro continuous glucose monitoring (CGM) system for up to 10 days. First and last eating times and any overnight eating were reported using daily surveys over the study duration. DP was expressed as a dichotomous variable at the day level (DP day vs non-DP day) and as a continuous variable reflecting the percent of days DP was experienced on a valid day. A valid day was defined as having no reported overnight eating (between midnight and 6 AM). ? Glucose was computed as the difference in nocturnal glucose nadir (between midnight and 6 AM) to morning preprandial glucose levels. ? Glucose ?20 mg/dL constituted a DP day. Using multilevel modeling, we examined the between- and within-person effects of DP on morning preprandial glucose and the effect of evening eating times on DP. Results: In total, 21 adults (59\% female; 13/21, 62\%) with non--insulin-treated T2DM wore a CGM for an average of 10.5 (SD 1.1) days. Twenty out of 21 participants (95\%) experienced DP for at least 1 day, with an average of 51\% of days (SD 27.2; range 0\%-100\%). The mean ? glucose was 23.7 (SD 13.2) mg/dL. People who experience DP more frequently had a morning preprandial glucose level that was 54.1 (95\% CI 17.0-83.9; P<.001) mg/dL higher than those who experienced DP less frequently. For within-person effect, morning preprandial glucose levels were 12.1 (95\% CI 6.3-17.8; P=.008) mg/dL higher on a DP day than on a non-DP day. The association between ? glucose and preprandial glucose levels was 0.50 (95\% CI 0.37-0.60; P<.001). There was no effect of the last eating time on DP. Conclusions: DP was experienced by most study participants regardless of last eating times. The magnitude of the within-person effect of DP on morning preprandial glucose levels was meaningful in the context of GGE. Alternative approaches for determining acceptable and effective GGE thresholds for people with T2DM should be explored and evaluated. ",
doi="10.2196/46034",
url="https://formative.jmir.org/2023/1/e46034",
url="http://www.ncbi.nlm.nih.gov/pubmed/37566445"
}


@Article{info:doi/10.2196/44348,
author="Glympi, Alkyoni
and Odegi, Dorothy
and Zandian, Modjtaba
and S{\"o}dersten, Per
and Bergh, Cecilia
and Langlet, Billy",
title="Eating Behavior and Satiety With Virtual Reality Meals Compared With Real Meals: Randomized Crossover Study",
journal="JMIR Serious Games",
year="2023",
month="Aug",
day="10",
volume="11",
pages="e44348",
keywords="exposure therapy",
keywords="eating behavior",
keywords="anorexia nervosa",
keywords="bulimia nervosa",
keywords="binge eating disorder",
keywords="overweight",
keywords="obesity",
keywords="immersive virtual reality",
keywords="VR",
keywords="virtual reality",
abstract="Background: Eating disorders and obesity are serious health problems with poor treatment outcomes and high relapse rates despite well-established treatments. Several studies have suggested that virtual reality technology could enhance the current treatment outcomes and could be used as an adjunctive tool in their treatment. Objective: This study aims to investigate the differences between eating virtual and real-life meals and test the hypothesis that eating a virtual meal can reduce hunger among healthy women. Methods: The study included 20 healthy women and used a randomized crossover design. The participants were asked to eat 1 introduction meal, 2 real meals, and 2 virtual meals, all containing real or virtual meatballs and potatoes. The real meals were eaten on a plate that had been placed on a scale that communicated with analytical software on a computer. The virtual meals were eaten in a room where participants were seated on a real chair in front of a real table and fitted with the virtual reality equipment. The eating behavior for both the real and virtual meals was filmed. Hunger was measured before and after the meals using questionnaires. Results: There was a significant difference in hunger from baseline to after the real meal (mean difference=61.8, P<.001) but no significant change in hunger from before to after the virtual meal (mean difference=6.9, P=.10). There was no significant difference in food intake between the virtual and real meals (mean difference=36.8, P=.07). Meal duration was significantly shorter in the virtual meal (mean difference=--5.4, P<.001), which led to a higher eating rate (mean difference=82.9, P<.001). Some participants took bites and chewed during the virtual meal, but the number of bites and chews was lower than in the real meal. The meal duration was reduced from the first virtual meal to the second virtual meal, but no significant difference was observed between the 2 real meals. Conclusions: Eating a virtual meal does not appear to significantly reduce hunger in healthy individuals. Also, this methodology does not significantly result in eating behaviors identical to real-life conditions but does evoke chewing and bite behavior in certain individuals. Trial Registration: ClinicalTrials.gov NCT05734209, https://clinicaltrials.gov/ct2/show/NCT05734209 ",
doi="10.2196/44348",
url="https://games.jmir.org/2023/1/e44348",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561558"
}


@Article{info:doi/10.2196/43959,
author="Bul, Kim
and Holliday, Nikki
and Bhuiyan, Alam Mohammad Rashed
and Clark, T. Cain C.
and Allen, John
and Wark, A. Petra",
title="Usability and Preliminary Efficacy of an Artificial Intelligence--Driven Platform Supporting Dietary Management in Diabetes: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Aug",
day="9",
volume="10",
pages="e43959",
keywords="nutrition and dietetics",
keywords="general diabetes",
keywords="qualitative research",
keywords="preventive medicine",
keywords="web technology",
keywords="self-management",
keywords="diabetes",
keywords="nutrition",
keywords="deep learning",
keywords="artificial",
keywords="mobile phone",
abstract="Background: Nutrition plays an important role in diabetes self-management. Web-based diabetes care, driven by artificial intelligence (AI), enables more personalized care. Objective: This study aimed to examine the usability and preliminary efficacy of a web-based AI-driven nutrition platform to support people with diabetes and their carers in identifying healthy recipes, meal planning, and web-based shopping. Methods: Diabetes UK signposted people with diabetes and their carers to the platform's study-specific portal through its website, social media, and newsletters. A total of 73 adult participants with prediabetes or diabetes or their carers completed the baseline web-based survey. Of these 73 participants, 23 (32\%) completed a web-based survey after 8 weeks of platform use. Web-based semistructured interviews were conducted with platform users (7/23, 30\%) who agreed to be followed up and diabetes experts (n=3) who had nutrition and platform knowledge. The intervention consists of a web-based platform that incorporates AI to personalize recipes, meal planning, and shopping list experiences and was made available for 8 weeks. Baseline characteristics, satisfaction, system usability, and diabetes-related and general health indicators were assessed before and after using the platform for 8 weeks. Results: Reductions in weight (mean difference 4.5 kg/m2, 95\% CI 1.0-12.0; P=.009; Cliff $\delta$=0.33) and waist size (mean difference 3.9 cm, 95\% CI 2.0-6.5; P=.008; Cliff $\delta$=0.48) were found. Most of the participants (151/217, 69.6\%) did not regularly use the platform and had low or very low engagement scores. However, the platform was perceived as accessible with no need for additional assistance (11/21, 52\%), user-friendly (8/21, 38\%), and easy to use (8/21, 38\%), regardless of some usability issues. Saving recipes was the most popular feature, with 663 saved recipes. Conclusions: This study indicated that the usability of the nutrition platform was well perceived by users and their carers. As participants managed their diabetes well, adding an education component would be specifically relevant for people less familiar with the role of diet in diabetes management. To assess the platform's effectiveness in improving diabetes-related health indicators, controlled studies with a larger and more diverse participant sample are recommended. ",
doi="10.2196/43959",
url="https://humanfactors.jmir.org/2023/1/e43959",
url="http://www.ncbi.nlm.nih.gov/pubmed/37556198"
}


@Article{info:doi/10.2196/46839,
author="Guan, Vivienne
and Zhou, Chenghuai
and Wan, Hengyi
and Zhou, Rengui
and Zhang, Dongfa
and Zhang, Sihan
and Yang, Wangli
and Voutharoja, Prakash Bhanu
and Wang, Lei
and Win, Than Khin
and Wang, Peng",
title="A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="7",
volume="7",
pages="e46839",
keywords="food",
keywords="diet",
keywords="mobile health",
keywords="mHealth",
keywords="persuasive technology",
keywords="gamification",
keywords="computer vision",
keywords="cloud computing",
keywords="design science research",
keywords="mobile phone",
abstract="Background: The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. Objective: This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. Methods: The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). Results: The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was ``acceptable,'' with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. Conclusions: A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development. ",
doi="10.2196/46839",
url="https://formative.jmir.org/2023/1/e46839",
url="http://www.ncbi.nlm.nih.gov/pubmed/37549000"
}


@Article{info:doi/10.2196/45079,
author="Severinsen, Frida
and Andersen, Frost Lene
and Paulsen, Mohn Mari",
title="The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Aug",
day="3",
volume="11",
pages="e45079",
keywords="dietary assessment",
keywords="malnutrition",
keywords="eHealth",
keywords="validation study",
keywords="older adults",
keywords="mobile phone",
abstract="Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ?65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ?65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants' experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ?80\% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60\% of the participants had ?80\% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74\% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants' dietary intake compared with the 24-hour recalls at both the individual and group levels. The app's ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. ",
doi="10.2196/45079",
url="https://mhealth.jmir.org/2023/1/e45079",
url="http://www.ncbi.nlm.nih.gov/pubmed/37535420"
}


@Article{info:doi/10.2196/46434,
author="Amiri, Maryam
and Li, Juan
and Hasan, Wordh",
title="Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="3",
volume="7",
pages="e46434",
keywords="diabetes",
keywords="fuzzy logic",
keywords="meal planning",
keywords="multicriteria decision-making",
keywords="optimization",
abstract="Background: Chronic diseases such as heart disease, stroke, diabetes, and hypertension are major global health challenges. Healthy eating can help people with chronic diseases manage their condition and prevent complications. However, making healthy meal plans is not easy, as it requires the consideration of various factors such as health concerns, nutritional requirements, tastes, economic status, and time limits. Therefore, there is a need for effective, affordable, and personalized meal planning that can assist people in choosing food that suits their individual needs and preferences. Objective: This study aimed to design an artificial intelligence (AI)--powered meal planner that can generate personalized healthy meal plans based on the user's specific health conditions, personal preferences, and status. Methods: We proposed a system that integrates semantic reasoning, fuzzy logic, heuristic search, and multicriteria analysis to produce flexible, optimized meal plans based on the user's health concerns, nutrition needs, as well as food restrictions or constraints, along with other personal preferences. Specifically, we constructed an ontology-based knowledge base to model knowledge about food and nutrition. We defined semantic rules to represent dietary guidelines for different health concerns and built a fuzzy membership of food nutrition based on the experience of experts to handle vague and uncertain nutritional data. We applied a semantic rule-based filtering mechanism to filter out food that violate mandatory health guidelines and constraints, such as allergies and religion. We designed a novel, heuristic search method that identifies the best meals among several candidates and evaluates them based on their fuzzy nutritional score. To select nutritious meals that also satisfy the user's other preferences, we proposed a multicriteria decision-making approach. Results: We implemented a mobile app prototype system and evaluated its effectiveness through a use case study and user study. The results showed that the system generated healthy and personalized meal plans that considered the user's health concerns, optimized nutrition values, respected dietary restrictions and constraints, and met the user's preferences. The users were generally satisfied with the system and its features. Conclusions: We designed an AI-powered meal planner that helps people create healthy and personalized meal plans based on their health conditions, preferences, and status. Our system uses multiple techniques to create optimized meal plans that consider multiple factors that affect food choice. Our evaluation tests confirmed the usability and feasibility of the proposed system. However, some limitations such as the lack of dynamic and real-time updates should be addressed in future studies. This study contributes to the development of AI-powered personalized meal planning systems that can support people's health and nutrition goals. ",
doi="10.2196/46434",
url="https://formative.jmir.org/2023/1/e46434",
url="http://www.ncbi.nlm.nih.gov/pubmed/37535413"
}


@Article{info:doi/10.2196/45294,
author="Hietbrink, G. Eclaire A.
and Oude Nijeweme-d'Hollosy, Wendy
and Middelweerd, Anouk
and Konijnendijk, J. Annemieke A.
and Schrijver, K. Laura
and ten Voorde, S. Anouk
and Fokkema, S. Elise M.
and Laverman, D. Gozewijn
and Vollenbroek-Hutten, R. Miriam M.",
title="A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing",
journal="JMIR Form Res",
year="2023",
month="Jul",
day="28",
volume="7",
pages="e45294",
keywords="eHealth",
keywords="type 2 diabetes",
keywords="physical activity",
keywords="nutrition",
keywords="lifestyle change",
keywords="acceptability",
keywords="limited efficacy",
keywords="formative evaluation",
keywords="mobile phone",
abstract="Background: A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. As many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools for supporting a healthy lifestyle. The E-Supporter 1.0 digital coach contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D. Objective: This study aimed to assess the acceptability of E-Supporter 1.0 and explore its limited efficacy on physical activity, dietary behavior, the phase of behavior change, and self-efficacy levels. Methods: Over a span of 9 weeks, 20 individuals with T2D received daily motivational messages and weekly feedback derived from behavioral change theories and determinants through E-Supporter 1.0. The acceptability of the intervention was assessed using telephone-conducted, semistructured interviews. The interview transcripts were coded using inductive thematic analysis. The limited efficacy of E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess physical activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale). Results: In total, 5 main themes emerged from the interviews: perceptions regarding remote coaching, perceptions regarding the content, intervention intensity and duration, perceived effectiveness, and overall appreciation. The participants were predominantly positive about E-Supporter 1.0. Overall, they experienced E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. Participants expressed a preference for combining E-Supporter with face-to-face guidance from a health care professional. Many participants found the intensity and duration of the intervention to be acceptable, despite the coaching period appearing relatively short to facilitate long-term behavior maintenance. As expected, the degree of tailoring concerning the individual and external factors that influence a healthy lifestyle was perceived as limited. The limited efficacy testing showed a significant improvement in the daily step count (z=?2.040; P=.04) and self-efficacy levels (z=?1.997; P=.046) between baseline and postintervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P=.17), as most participants were already in the maintenance phase at baseline. Conclusions: On the basis of this explorative feasibility study, we expect E-Supporter 1.0 to be an acceptable and potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further tailor the E-Supporter content and evaluate its effects more extensively on lifestyle behaviors. ",
doi="10.2196/45294",
url="https://formative.jmir.org/2023/1/e45294",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505804"
}


@Article{info:doi/10.2196/47877,
author="M{\"u}ssener, Ulrika
and Henriksson, Pontus
and Gustavsson, Catharina
and Henriksson, Hanna
and Tyrberg, J. M{\aa}rten
and Johansson, Stefan
and Alfredsson {\AA}gren, Kristin",
title="Promoting Healthy Behaviors Among Adolescents and Young Adults With Intellectual Disability: Protocol for Developing a Digital Intervention With Co-Design Workshops",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="28",
volume="12",
pages="e47877",
keywords="intellectual disability",
keywords="lifestyle behavior",
keywords="eHealth",
keywords="co-design",
keywords="digital intervention",
keywords="lifestyle",
keywords="adolescents",
keywords="young adult",
keywords="healthy diet",
abstract="Background: Intellectual disability (ID) is a neurodevelopmental disorder associated with a poorer health profile and higher mortality. Young people with ID have more sedentary lifestyles than their typically developing peers. Consequently, this group is at significant risk of developing lifestyle diseases (ie, noncommunicable diseases) later in life. Increasing physical activity and eating a healthier diet have been argued to be effective ways to improve the health of adolescents and young adults with ID. Digital interventions are a viable option for improving health behaviors. Objective: This research protocol describes a co-design approach using workshops to develop a digital intervention that promotes healthy behaviors, including increasing physical activity and eating a healthier diet, among adolescents and young adults with ID. Methods: A participatory design using a co-design approach will be applied as a strategy to include potential users of the digital intervention and other stakeholders in the research process, comprising research design, data collection, and data analysis. A total of 7 to 10 workshops will be conducted aimed at developing a digital intervention and will include procedures for assessing needs; facilitators and barriers to health promotion; physical, mental, and social well-being; participation; and relationships. The workshops will include 12 to 18 stakeholders with experience of clinical practice and research related to young people with ID, including relatives, as well as adolescents and young adults (aged 16-25 years) with mild to moderate ID. Participants will perform a mixture of individual and group work using whiteboards, sticky notes, felt-tip pens, cards, balls, stickers, and wireframe templates. Data analysis will take place concurrently with data collection as an iterative process. Transcribed data from the audio and video recordings of the groups' discussions will be analyzed following a qualitative methodological procedure. Results: This study protocol provides a systematic record of the scientific methodologies used when developing the digital intervention and provides insights into the potential practical solutions and challenges when following a co-design approach in which relatives and professionals, as well as adolescents and young adults with ID, are included as research partners. Recruitment of participants started in April 2023. Data collection, analysis, and reporting will be completed in December 2023. Conclusions: This study will explore the effectiveness of workshops at gathering rich, reliable, and valid data in a co-design approach with participants. The results will provide increased knowledge in how to use technology to develop novel, evidence-based, and scalable interventions that adolescents and young adults with ID can and want to use to motivate physical activity and a healthier diet. The project will provide a simple and cognitively accessible digital solution for promoting lifestyle behaviors tailored to the needs of adolescents and young adults with ID. International Registered Report Identifier (IRRID): PRR1-10.2196/47877 ",
doi="10.2196/47877",
url="https://www.researchprotocols.org/2023/1/e47877",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505807"
}


@Article{info:doi/10.2196/45098,
author="Mey, T. Jacob
and Karpinski, A. Christine
and Yang, Shengping
and Madere, D. Joseph
and Piattoly, Tavis
and Harper, Ronnie
and Kirwan, P. John",
title="Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions",
journal="JMIR Form Res",
year="2023",
month="Jul",
day="26",
volume="7",
pages="e45098",
keywords="dietitian",
keywords="malnutrition",
keywords="mHealth",
keywords="mobile health",
keywords="performance",
keywords="RED-S",
keywords="relative energy deficiency in sport",
keywords="sports nutrition",
keywords="technology",
abstract="Background: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). Objective: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes' and sport professionals' perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. Methods: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Results: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. ``Health'' and ``sports performance'' were the highest scoring motivators, while the highest scoring barriers were ``cost of food,'' ``easy access to unhealthy food,'' and ``time to cook or prepare food.'' Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. Conclusions: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance. ",
doi="10.2196/45098",
url="https://formative.jmir.org/2023/1/e45098",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494083"
}


@Article{info:doi/10.2196/36132,
author="Kulandaivelu, Yalinie
and Hamilton, Jill
and Banerjee, Ananya
and Gruzd, Anatoliy
and Patel, Barkha
and Stinson, Jennifer",
title="Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="20",
volume="6",
pages="e36132",
keywords="adolescents",
keywords="digital health intervention",
keywords="food literacy",
keywords="health literacy",
keywords="nutrition",
keywords="peer education",
keywords="peer support",
keywords="social media",
abstract="Background: Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media--based nutrition education interventions to inform the implementation of future social media--based nutrition education interventions. Objective: A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media--based nutrition education interventions for adolescents was conducted. Methods: We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media--based nutrition education interventions was extracted. Results: A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied. Conclusions: Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media--based nutrition interventions and the need for user-centered design of the interventions. ",
doi="10.2196/36132",
url="https://pediatrics.jmir.org/2023/1/e36132",
url="http://www.ncbi.nlm.nih.gov/pubmed/37471119"
}


@Article{info:doi/10.2196/45057,
author="Crane, Nicole
and Hagerman, Charlotte
and Horgan, Olivia
and Butryn, Meghan",
title="Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jul",
day="18",
volume="11",
pages="e45057",
keywords="weight loss",
keywords="digital technology",
keywords="diet",
keywords="exercise",
keywords="behavior change",
keywords="mobile phone",
abstract="Background: Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging; therefore, more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). In addition, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence. Objective: This study explored patterns of digital SM of weight, diet, and exercise during WLM (aim 1) and examined timing, patterns, and rates of disengagement and reengagement (aim 2). This study also assessed relationships between individual-level factors (weight-related information avoidance and weight bias internalization) and SM engagement (aim 3). Methods: Participants were 72 adults enrolled in a BWL program consisting of a 3-month period of weekly treatment designed to induce weight loss (phase I), followed by a 9-month period of less frequent contact to promote WLM (phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with the days per month that participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multilevel modeling examined changes in adherence across phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, 2-tailed independent samples t tests, and multilevel modeling. Results: During WLM, consistently high rates of SM (?50\% of the days in each month) were observed for 61\% (44/72) of the participants for exercise, 40\% (29/72) of the participants for weight, and 21\% (15/72) of the participants for diet. Adherence for SM of exercise was higher than that for weight or diet (P<.001). Adherence decreased over time for all SM targets throughout phase II (P<.001), but SM of exercise dropped off later in WLM (mean 10.07, SD 2.83 months) than SM of weight (mean 7.92, SD 3.23 months) or diet (mean 7.58, SD 2.92 months; P<.001). Among participants with a period of low SM adherence (ie, <50\% of the days in a month), only 33\% (17/51 for weight, 19/57 for diet) to 46\% (13/28 for exercise) subsequently had ?1 months with high adherence. High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P<.001). Participants with high weight bias internalization had the highest rates of weight SM (P=.03). Conclusions: Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Weight-related information avoidance and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement. ",
doi="10.2196/45057",
url="https://mhealth.jmir.org/2023/1/e45057",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463017"
}


@Article{info:doi/10.2196/47328,
author="Shankar, Kavitha
and Chandrasekaran, Ranganathan
and Jeripity Venkata, Pruthvinath
and Miketinas, Derek",
title="Investigating the Role of Nutrition in Enhancing Immunity During the COVID-19 Pandemic: Twitter Text-Mining Analysis",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="10",
volume="25",
pages="e47328",
keywords="social media",
keywords="nutrition discourse",
keywords="text mining",
keywords="immunity building",
keywords="food groups",
keywords="Twitter",
keywords="nutrition",
keywords="food",
keywords="immunity",
keywords="COVID-19",
keywords="diet",
keywords="immune system",
keywords="assessment",
keywords="tweets",
keywords="dieticians",
keywords="nutritionists",
abstract="Background: The COVID-19 pandemic has brought to the spotlight the critical role played by a balanced and healthy diet in bolstering the human immune system. There is burgeoning interest in nutrition-related information on social media platforms like Twitter. There is a critical need to assess and understand public opinion, attitudes, and sentiments toward nutrition-related information shared on Twitter. Objective: This study uses text mining to analyze nutrition-related messages on Twitter to identify and analyze how the general public perceives various food groups and diets for improving immunity to the SARS-CoV-2 virus. Methods: We gathered 71,178 nutrition-related tweets that were posted between January 01, 2020, and September 30, 2020. The Correlated Explanation text mining algorithm was used to identify frequently discussed topics that users mentioned as contributing to immunity building against SARS-CoV-2. We assessed the relative importance of these topics and performed a sentiment analysis. We also qualitatively examined the tweets to gain a closer understanding of nutrition-related topics and food groups. Results: Text-mining yielded 10 topics that users discussed frequently on Twitter, viz proteins, whole grains, fruits, vegetables, dairy-related, spices and herbs, fluids, supplements, avoidable foods, and specialty diets. Supplements were the most frequently discussed topic (23,913/71,178, 33.6\%) with a higher proportion (20,935/23,913, 87.75\%) exhibiting a positive sentiment with a score of 0.41. Consuming fluids (17,685/71,178, 24.85\%) and fruits (14,807/71,178, 20.80\%) were the second and third most frequent topics with favorable, positive sentiments. Spices and herbs (8719/71,178, 12.25\%) and avoidable foods (8619/71,178, 12.11\%) were also frequently discussed. Negative sentiments were observed for a higher proportion of avoidable foods (7627/8619, 84.31\%) with a sentiment score of --0.39. Conclusions: This study identified 10 important food groups and associated sentiments that users discussed as a means to improve immunity. Our findings can help dieticians and nutritionists to frame appropriate interventions and diet programs. ",
doi="10.2196/47328",
url="https://www.jmir.org/2023/1/e47328",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428522"
}


@Article{info:doi/10.2196/45983,
author="Gilbert, Stephanie
and Irvine, Rachel
and D'or, Melissa
and Adam, P. Marc T.
and Collins, E. Clare
and Marriott, Rhonda
and Rollo, Megan
and Walker, Roz
and Rae, Kym",
title="Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="6",
volume="12",
pages="e45983",
keywords="co-design",
keywords="community-based participatory research",
keywords="mHealth",
keywords="Aboriginal and Torres Strait Islander",
keywords="maternal health",
keywords="pregnancy",
keywords="nutrition",
keywords="Indigenous women",
keywords="diet",
keywords="health literacy",
keywords="Indigenous",
keywords="Indigenous people",
keywords="mobile phone",
abstract="Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people's food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. Objective: This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. Methods: The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. Results: To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. Conclusions: This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. International Registered Report Identifier (IRRID): DERR1-10.2196/45983 ",
doi="10.2196/45983",
url="https://www.researchprotocols.org/2023/1/e45983",
url="http://www.ncbi.nlm.nih.gov/pubmed/37147188"
}


@Article{info:doi/10.2196/43426,
author="Kohl, Jan
and Brame, Judith
and Centner, Christoph
and Wurst, Ramona
and Fuchs, Reinhard
and Sehlbrede, Matthias
and Tinsel, Iris
and Maiwald, Phillip
and Fichtner, Alexander Urs
and Armbruster, Christoph
and Farin-Glattacker, Erik
and Gollhofer, Albert
and K{\"o}nig, Daniel",
title="Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="27",
volume="25",
pages="e43426",
keywords="web-based intervention",
keywords="randomized controlled trial",
keywords="dietary energy density",
keywords="weight loss, obesity",
keywords="overweight",
keywords="cardiometabolic risk factors",
abstract="Background: The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support. Objective: The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program. Methods: The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m2 (mean 30.71, SD 2.13 kg/m2). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes. Results: The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7\%) in the intervention group versus 1.29 kg (1.5\%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups. Conclusions: The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy. Trial Registration: German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249 International Registered Report Identifier (IRRID): RR2-10.3390/ijerph19031393  ",
doi="10.2196/43426",
url="https://www.jmir.org/2023/1/e43426",
url="http://www.ncbi.nlm.nih.gov/pubmed/37368484"
}


@Article{info:doi/10.2196/39515,
author="van der Haar, Sandra
and Raaijmakers, Ireen
and Verain, D. Muriel C.
and Meijboom, Saskia",
title="Incorporating Consumers' Needs in Nutrition Apps to Promote and Maintain Use: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="20",
volume="11",
pages="e39515",
keywords="mobile health",
keywords="mHealth",
keywords="mHealth apps",
keywords="nutrition apps",
keywords="diet apps",
keywords="consumer needs",
keywords="app",
keywords="use",
keywords="nutrition",
keywords="tool",
keywords="consumer",
keywords="eating",
keywords="habit",
keywords="users",
keywords="dietary behavior",
keywords="reliable",
keywords="food",
keywords="database",
keywords="time",
keywords="developers",
keywords="mobile phone",
abstract="Background: Nutrition apps seem to be promising tools for supporting consumers toward healthier eating habits. There is a wide variety of nutrition apps available; however, users often discontinue app use at an early stage before a permanent change in dietary behavior can be achieved. Objective: The main objective of this study was to identify, from both a user and nonuser perspective, which functionalities should be included in nutrition apps to increase intentions to start and maintain use of these apps. A secondary objective was to gain insight into reasons to quit using nutrition apps at an early stage. Methods: This study used a mixed methods approach and included a qualitative and a quantitative study. The qualitative study (n=40) consisted of a home-use test with 6 commercially available nutrition apps, followed by 6 focus group discussions (FGDs) to investigate user experiences. The quantitative study was a large-scale survey (n=1420), which was performed in a representative sample of the Dutch population to quantify the FGDs' results. In the survey, several app functionalities were rated on 7-point Likert scales ranging from 1 (very unimportant) to 7 (very important). Results: A total of 3 different phases of app use, subdivided into 10 user-centric app aspects and 46 associated app functionalities, were identified as relevant nutrition app elements in the FGDs. Relevance was confirmed in the survey, as all user-centric aspects and almost all app functionalities were rated as important to include in a nutrition app. In the starting phase, a clear introduction (mean 5.45, SD 1.32), purpose (mean 5.40, SD 1.40), and flexible food tracking options (mean 5.33, SD 1.45) were the most important functionalities. In the use phase, a complete and reliable food product database (mean 5.58, SD 1.41), easy navigation (mean 5.56, SD 1.36), and limited advertisements (mean 5.53, SD 1.51) were the most important functionalities. In the end phase, the possibility of setting realistic goals (mean 5.23, SD 1.44), new personal goals (mean 5.13, SD 1.45), and continuously offering new information (mean 4.88, SD 1.44) were the most important functionalities. No large differences between users, former users, and nonusers were found. The main reason for quitting a nutrition app in the survey was the high time investment (14/38, 37\%). This was also identified as a barrier in the FGDs. Conclusions: Nutrition apps should be supportive in all 3 phases of use (start, use, and end) to increase consumers' intentions to start and maintain the use of these apps and achieve a change in dietary behavior. Each phase includes several key app functionalities that require specific attention from app developers. High time investment is an important reason to quit nutrition app use at an early stage. ",
doi="10.2196/39515",
url="https://mhealth.jmir.org/2023/1/e39515",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338978"
}


@Article{info:doi/10.2196/35858,
author="Gioia, Siena
and Vlasac, M. Irma
and Babazadeh, Demsina
and Fryou, L. Noah
and Do, Elizabeth
and Love, Jessica
and Robbins, Rebecca
and Dashti, S. Hassan
and Lane, M. Jacqueline",
title="Mobile Apps for Dietary and Food Timing Assessment: Evaluation for Use in Clinical Research",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="16",
volume="7",
pages="e35858",
keywords="dietary assessment",
keywords="mobile phone",
keywords="smartphone",
keywords="nutrition apps",
keywords="dietary record",
keywords="circadian rhythms",
keywords="food diary",
keywords="food timing",
abstract="Background: Over the last decade, health mobile apps have become an increasingly popular tool used by clinicians and researchers to track food consumption and exercise. However, many consumer apps lack the technological features for facilitating the capture of critical food timing details. Objective: This study aimed to introduce users to 11 apps from US app stores that recorded both dietary intake and food timing to establish which one would be the most appropriate for clinical research. Methods: To determine a viable app that recorded both dietary intake and food timing for use in a food timing--related clinical study, we evaluated the time stamp data, usability, privacy policies, the accuracy of nutrient estimates, and general features of 11 mobile apps for dietary assessment that were available on US app stores. The following apps were selected using a keyword search of related terms and reviewed: text entry apps---Cronometer, DiaryNutrition, DietDiary, FoodDiary, Macros, and MyPlate; image entry apps---FoodView and MealLogger; and text plus image entry apps---Bitesnap, myCircadianClock, and MyFitnessPal. Results: Our primary goal was to identify apps that recorded food time stamps, which 8 (73\%) of the 11 reviewed apps did. Of the 11 apps, only 4 (36\%) allowed users to edit the time stamps. Next, we sought to evaluate the usability of the apps using the System Usability Scale across 2 days, and 82\% (9/11) of the apps received favorable scores for usability. To enable use in research and clinical settings, the privacy policies of each app were systematically reviewed using common criteria, with 1 (9\%) Health Insurance Portability and Accountability Act--compliant app (Cronometer). Furthermore, protected health information was collected by 9 (82\%) of the 11 apps. Finally, to assess the accuracy of the nutrient estimates generated by these apps, we selected 4 sample food items and a 3-day dietary record to input into each app. The caloric and macronutrient estimates of the apps were compared with the nutrient estimates provided by a registered dietitian using the Nutrition Data System for Research database. In terms of the 3-day food record, the apps were found to consistently underestimate daily calories and macronutrients compared with the Nutrition Data System for Research output. Conclusions: Overall, we found that the Bitesnap app provided flexible dietary and food timing functionality capable of being used in research and clinical settings, whereas most other apps lacked in the necessary food timing functionality or user privacy. ",
doi="10.2196/35858",
url="https://formative.jmir.org/2023/1/e35858",
url="http://www.ncbi.nlm.nih.gov/pubmed/37327038"
}


@Article{info:doi/10.2196/42114,
author="Nicol, E. Ginger
and Jansen, O. Madeline
and Ricchio, R. Amanda
and Schweiger, A. Julia
and Keenoy, E. Katie
and Miller, Philip J.
and Morrato, H. Elaine
and Guo, Zhaohua
and Evanoff, A. Bradley
and Parks, J. Joseph
and Newcomer, W. John",
title="Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Protocol for a Mixed Methods Implementation and Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="9",
volume="12",
pages="e42114",
keywords="community mental health services",
keywords="implementation science",
keywords="mental disorders",
keywords="obesity",
keywords="primary prevention",
abstract="Background: Obesity is common in individuals with severe mental illness (SMI), contributing to a significantly shortened lifespan when compared to the general population. Available weight loss treatments have attenuated efficacy in this population, underscoring the importance of prevention and early intervention. Objective: Here, we describe a type 1 hybrid study design for adapting and pilot-testing an existing mobile health intervention for obesity prevention in individuals with early SMI and Class I or early-stage obesity, defined as a BMI of 30-35. Methods: An existing, evidence-based interactive obesity treatment approach using low-cost, semiautomated SMS text messaging was selected for adaptation. Community mental health clinics and Clubhouse settings in Eastern Missouri and South Florida were identified to participate. This study has the following 3 aims. First, using the Enhanced Framework for Reporting Adaptations and Modifications to Evidence-based interventions, contextual aspects of the clinical and digital treatment environments are identified for adaptation, considering 5 main stakeholder groups (clinical administrators, prescribing clinicians, case managers, nurses, and patients). Following a 2-week trial of unadapted SMS text messaging, Innovation Corps methods are used to discover needed intervention adaptations by stakeholder group and clinical setting. Second, adaptations to digital functionality and intervention content will be made based on themes identified in aim 1, followed by rapid usability testing with key stakeholders. A process for iterative treatment adaptation will be developed for making unplanned modifications during the aim 3 implementation pilot study. Individuals working in partner community mental health clinics and Clubhouse settings will be trained in intervention delivery. Third, in a randomized pilot and feasibility trial, adults with 5 years or less of treatment for an SMI diagnosis will be randomized 2:1 to 6 months of an adapted interactive obesity treatment approach or to an attentional control condition, followed by a 3-month extension phase of SMS text messages only. Changes in weight, BMI, and behavioral outcomes, as well as implementation challenges, will be evaluated at 6 and 9 months. Results: Institutional review board approval for aims 1 and 2 was granted on August 12, 2018, with 72 focus group participants enrolled; institutional review board approval for aim 3 was granted on May 6, 2020. To date, 52 participants have been enrolled in the study protocol. Conclusions: In this type 1 hybrid study design, we apply an evidence-based treatment adaptation framework to plan, adapt, and feasibility test a mobile health intervention in real-world treatment settings. Resting at the intersection of community mental health treatment and physical health promotion, this study aims to advance the use of simple technology for obesity prevention in individuals with early-stage mental illness. Trial Registration: ClinicalTrials.gov NCT03980743; https://clinicaltrials.gov/ct2/show/NCT03980743 International Registered Report Identifier (IRRID): DERR1-10.2196/42114 ",
doi="10.2196/42114",
url="https://www.researchprotocols.org/2023/1/e42114",
url="http://www.ncbi.nlm.nih.gov/pubmed/37294604"
}


@Article{info:doi/10.2196/42001,
author="Jiwa, Moyez
and Nyanhanda, Tafadzwa
and Dodson, Michael",
title="Triggering Weight Management Using Digital Avatars: Prospective Cohort Study",
journal="Interact J Med Res",
year="2023",
month="May",
day="29",
volume="12",
pages="e42001",
keywords="weight management",
keywords="digital avatar, behavior change, calorie awareness, obesity, health promotion, motivation, processes of change",
keywords="stages of change",
keywords="BMI",
keywords="weight",
keywords="body dysmorphia",
keywords="diet",
keywords="exercise",
keywords="calorie",
keywords="tool",
keywords="digital",
abstract="Background: There is evidence that showing motivated people with a less-than-ideal BMI (>25 kg/m2) digital and personalized images of their future selves with reduced body weight will likely trigger them to achieve that new body weight. Objective: The purpose of this study is to assess whether digital avatars can trigger weight management action and identify some of the measurable factors that distinguish those who may be triggered. Methods: A prospective cohort study followed participants for 12 weeks through 5 recorded interviews. Participants were screened for suitability for the study using the Cosmetic Procedure Screening Questionnaire as a measure of body dysmorphia. At interview 1, participants were shown 10 images from a ``Food-pics'' database and invited to estimate their calorie value. The intervention, the FutureMe app, delivered at interview 2, provided each participant an opportunity to see and take away a soft copy of an avatar of themselves as they might appear in the future depending on their calorie consumption and exercise regimen. Participants completed the readiness for change (S-Weight) survey based on Prochaska Stages of Change Model and the processes of change (P-Weight) survey. Any changes in diet, exercise, or weight were self-reported. Results: A total of 87 participants were recruited, and 42 participants completed the study (48\% of recruited participants). Body dysmorphia was a rare but possible risk to participation. The majority (88.5\%) of the participants were female and older than 40 years. The average BMI was 34.1 (SD 4.8). Most people wanted to reduce to a BMI of 30 kg/m2 or lose on average 10.5 kg within 13 weeks (--0.8 kg per week). Most participants stated that they would achieve these results by limiting their calorie intake to 1500 calories per day and taking the equivalent of 1 hour of bicycling per day. At interview 1, more participants were in the preparation stage of behavior change than in subsequent interviews. By interview 5, most of the participants were at the maintenance stage. Participants who overestimated the recommended number of calories were more likely to be in the contemplation stage (P=.03). Conclusions: Volunteers who participated in the study were mainly women older than 40 years and beyond the contemplation stage of change for weight management, and those who took weight management action were demonstrated to have a more accurate idea of the calorie content of different foods. Most participants set ambitious targets for weight loss, but few, if any, achieve these goals. However, most people who completed this study were actively taking action to manage their weight. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001481167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378055\&isReview=true ",
doi="10.2196/42001",
url="https://www.i-jmr.org/2023/1/e42001",
url="http://www.ncbi.nlm.nih.gov/pubmed/37247208"
}


@Article{info:doi/10.2196/42238,
author="Noh, Eunyoung
and Won, Jiyoon
and Jo, Sua
and Hahm, Dae-Hyun
and Lee, Hyangsook",
title="Conversational Agents for Body Weight Management: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="26",
volume="25",
pages="e42238",
keywords="conversational agent",
keywords="chatbot",
keywords="obesity",
keywords="weight management",
keywords="artificial intelligence",
keywords="behavioral therapy",
abstract="Background: Obesity is a public health issue worldwide. Conversational agents (CAs), also frequently called chatbots, are computer programs that simulate dialogue between people. Owing to better accessibility, cost-effectiveness, personalization, and compassionate patient-centered treatments, CAs are expected to have the potential to provide sustainable lifestyle counseling for weight management. Objective: This systematic review aimed to critically summarize and evaluate clinical studies on the effectiveness and feasibility of CAs with unconstrained natural language input for weight management. Methods: PubMed, Embase, the Cochrane Library (CENTRAL), PsycINFO, and ACM Digital Library were searched up to December 2022. Studies were included if CAs were used for weight management and had a capability for unconstrained natural language input. No restrictions were imposed on study design, language, or publication type. The quality of the included studies was assessed using the Cochrane risk-of-bias assessment tool or the Critical Appraisal Skills Programme checklist. The extracted data from the included studies were tabulated and narratively summarized as substantial heterogeneity was expected. Results: In total, 8 studies met the eligibility criteria: 3 (38\%) randomized controlled trials and 5 (62\%) uncontrolled before-and-after studies. The CAs in the included studies were aimed at behavior changes through education, advice on food choices, or counseling via psychological approaches. Of the included studies, only 38\% (3/8) reported a substantial weight loss outcome (1.3-2.4 kg decrease at 12-15 weeks of CA use). The overall quality of the included studies was judged as low. Conclusions: The findings of this systematic review suggest that CAs with unconstrained natural language input can be used as a feasible interpersonal weight management intervention by promoting engagement in psychiatric intervention-based conversations simulating treatments by health care professionals, but currently there is a paucity of evidence. Well-designed rigorous randomized controlled trials with larger sample sizes, longer treatment duration, and follow-up focusing on CAs' acceptability, efficacy, and safety are warranted. ",
doi="10.2196/42238",
url="https://www.jmir.org/2023/1/e42238",
url="http://www.ncbi.nlm.nih.gov/pubmed/37234029"
}


@Article{info:doi/10.2196/41114,
author="Sanders, P. James
and Gokal, Kajal
and Thomas, C. Jonah J.
and Rawstorn, C. Jonathan
and Sherar, B. Lauren
and Maddison, Ralph
and Greaves, J. Colin
and Esliger, Dale
and Daley, J. Amanda
and ",
title="Development of a Mobile Health Snacktivity App to Promote Physical Activity in Inactive Adults (SnackApp): Intervention Mapping and User Testing Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="22",
volume="7",
pages="e41114",
keywords="intervention development",
keywords="physical activity",
keywords="mobile health",
keywords="mHealth",
keywords="health app",
keywords="user testing",
keywords="intervention",
keywords="behavior",
keywords="smartphone",
keywords="app",
keywords="social",
keywords="user",
keywords="engagement",
keywords="development",
keywords="testing",
keywords="mobile phone",
abstract="Background: Despite the unequivocal evidence demonstrating the benefits of being physically active, many people do not meet the recommended guidelines of at least 150 minutes of moderate- to vigorous-intensity physical activity per week. This can be changed with the development and implementation of innovative interventions. The use of mobile health (mHealth) technologies has been suggested as a mechanism to offer people innovative health behavior change interventions. Objective: This study aims to outline the systematic, theory-driven processes and user testing applied to the development of a smartphone-based physical activity app (SnackApp) to promote participation in a novel physical activity intervention called Snacktivity. The acceptability of the app was explored and reported. Methods: Intervention mapping involves a 6-step process, the first 4 of which were presented in this study. These steps were used to develop the SnackApp for use within the Snacktivity intervention. The first step involved a needs assessment, which included composing an expert planning group, patient and public involvement group, and gathering the views of the public on Snacktivity and the public perception of the use of wearable technology to support Snacktivity. This first step aimed to determine the overall purpose of the Snacktivity intervention. Steps 2 to 4 involved determining the intervention objectives, the behavior change theory and techniques on which the intervention is based, and the development of the intervention resources (ie, SnackApp). After the completion of steps 1 to 3 of the intervention mapping process, the SnackApp was developed and linked to a commercial physical activity tracker (Fitbit Versa Lite) for the automated capture of physical activity. SnackApp includes provisions for goal setting, activity planning, and social support. Stage 4 involved users (inactive adults, N=15) testing the SnackApp for 28 days. App engagement (mobile app use analytics) was analyzed to determine app use and to inform the further development of SnackApp. Results: Over the study period (step 4), participants engaged with SnackApp an average of 77 (SD 80) times. On average, participants used the SnackApp for 12.6 (SD 47) minutes per week, with most of the time spent on the SnackApp dashboard and engaging, on average, 14 (SD 12.1) times, lasting 7 to 8 minutes per week. Overall, male participants used the SnackApp more than female participants did. The app rating score was 3.5 (SD 0.6) out of 5, suggesting that SnackApp was rated as fair to good. Conclusions: This study outlines and reports data regarding the development of an innovative mHealth app using a systematic, theory-driven framework. This approach can guide the development of future mHealth programs. User testing of the SnackApp suggested that physically inactive adults will engage with the SnackApp, indicating its applicability of use in the Snacktivity physical activity intervention. ",
doi="10.2196/41114",
url="https://formative.jmir.org/2023/1/e41114",
url="http://www.ncbi.nlm.nih.gov/pubmed/37213198"
}


@Article{info:doi/10.2196/46659,
author="Chikwetu, Lucy
and Daily, Shaundra
and Mortazavi, J. Bobak
and Dunn, Jessilyn",
title="Automated Diet Capture Using Voice Alerts and Speech Recognition on Smartphones: Pilot Usability and Acceptability Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="16",
volume="7",
pages="e46659",
keywords="automatic dietary monitoring",
keywords="ADM",
keywords="food logging",
keywords="diet logging",
keywords="voice technologies",
keywords="voice alert",
keywords="speech recognition",
keywords="natural language processing",
keywords="NLP",
abstract="Background: Effective monitoring of dietary habits is critical for promoting healthy lifestyles and preventing or delaying the onset and progression of diet-related diseases, such as type 2 diabetes. Recent advances in speech recognition technologies and natural language processing present new possibilities for automated diet capture; however, further exploration is necessary to assess the usability and acceptability of such technologies for diet logging. Objective: This study explores the usability and acceptability of speech recognition technologies and natural language processing for automated diet logging. Methods: We designed and developed base2Diet---an iOS smartphone application that prompts users to log their food intake using voice or text. To compare the effectiveness of the 2 diet logging modes, we conducted a 28-day pilot study with 2 arms and 2 phases. A total of 18 participants were included in the study, with 9 participants in each arm (text: n=9, voice: n=9). During phase I of the study, all 18 participants received reminders for breakfast, lunch, and dinner at preselected times. At the beginning of phase II, all participants were given the option to choose 3 times during the day to receive 3 times daily reminders to log their food intake for the remainder of the phase, with the ability to modify the selected times at any point before the end of the study. Results: The total number of distinct diet logging events per participant was 1.7 times higher in the voice arm than in the text arm (P=.03, unpaired t test). Similarly, the total number of active days per participant was 1.5 times higher in the voice arm than in the text arm (P=.04, unpaired t test). Furthermore, the text arm had a higher attrition rate than the voice arm, with only 1 participant dropping out of the study in the voice arm, while 5 participants dropped out in the text arm. Conclusions: The results of this pilot study demonstrate the potential of voice technologies in automated diet capturing using smartphones. Our findings suggest that voice-based diet logging is more effective and better received by users compared to traditional text-based methods, underscoring the need for further research in this area. These insights carry significant implications for the development of more effective and accessible tools for monitoring dietary habits and promoting healthy lifestyle choices. ",
doi="10.2196/46659",
url="https://formative.jmir.org/2023/1/e46659",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191989"
}


@Article{info:doi/10.2196/44295,
author="Saslow, R. Laura
and Missel, L. Amanda
and O'Brien, Alison
and Kim, Sarah
and Hecht, M. Frederick
and Moskowitz, T. Judith
and Bayandorian, Hovig
and Pietrucha, Martha
and Raymond, Kate
and Richards, Blair
and Liestenfeltz, Bradley
and Mason, E. Ashley
and Daubenmier, Jennifer
and Aikens, E. James",
title="Psychological Support Strategies for Adults With Type 2 Diabetes in a Very Low--Carbohydrate Web-Based Program: Randomized Controlled Trial",
journal="JMIR Diabetes",
year="2023",
month="May",
day="11",
volume="8",
pages="e44295",
keywords="eHealth",
keywords="type 2 diabetes",
keywords="T2D",
keywords="very low--carbohydrate diet",
keywords="weight loss",
keywords="glycemic control",
keywords="text messages",
keywords="self-monitoring",
abstract="Background: A very low--carbohydrate (VLC) nutritional strategy may improve glycemic control and weight loss in adults with type 2 diabetes (T2D). However, the supplementary behavioral strategies that might be able to improve outcomes using this nutritional strategy are uncertain. Objective: This study aims to compare the impact of adding 3 different supplementary behavioral strategies to a web-based VLC diet intervention. To our knowledge, this is the first trial to randomize participants to different frequencies of dietary self-monitoring. Methods: The study included 112 overweight adults with T2D (hemoglobin A1c ?6.5\%) taking no antiglycemic medications or only metformin. They received a remotely delivered 12-month VLC diet intervention. Participants were randomly assigned through a full factorial 2{\texttimes}2{\texttimes}2 design to supplementary strategies: either daily or monthly dietary self-monitoring, either mindful eating training or not, and either positive affect skills training or not. Our research goal was to determine whether 3 different supplemental strategies had at least a medium effect size (Cohen d=0.5). Results: Overall, the VLC intervention led to statistically significant improvements in glycemic control (?0.70\%, 95\% CI ?1.04\% to ?0.35\%; P<.001), weight loss (?6.82\%, 95\% CI ?8.57\% to ?5.08\%; P<.001), and depressive symptom severity (Cohen d ?0.67, 95\% CI ?0.92 to ?0.41; P<.001). Furthermore, 30\% (25/83) of the participants taking metformin at baseline reduced or discontinued their metformin. Only 1 Cohen d point estimate reached 0.5; daily (vs monthly) dietary self-monitoring had a worse impact on depressive symptoms severity (Cohen d=0.47, 95\% CI ?0.02 to 0.95; P=.06). None of the strategies had a statistically significant effect on outcomes. For changes in our primary outcome, hemoglobin A1c, the daily (vs monthly) dietary self-monitoring impact was 0.42\% (95\% CI ?0.28\% to 1.12\%); for mindful eating, it was ?0.47\% (95\% CI ?1.15\% to 0.22\%); and for positive affect, it was 0.12\% (95\% CI ?0.57\% to 0.82\%). Other results for daily (vs monthly) dietary self-monitoring were mixed, suggesting an increase in weight (0.98\%) and depressive symptoms (Cohen d=0.47), less intervention satisfaction (Cohen d=?0.20), more sessions viewed (3.02), and greater dietary adherence (Cohen d=0.24). For mindful eating, the results suggested a benefit for dietary adherence (Cohen d=0.24) and intervention satisfaction (Cohen d=0.30). For positive affect, the results suggested a benefit for depressive symptoms (Cohen d=?0.32), the number of sessions viewed (3.68), dietary adherence (Cohen d=0.16), and intervention satisfaction (Cohen d=0.25). Conclusions: Overall, our results support the use of a VLC diet intervention in adults with T2D. The addition of monthly (not daily) dietary self-monitoring, mindful eating, and positive affect skills training did not show a definitive benefit, but it is worth further testing. Trial Registration: ClinicalTrials.gov NCT03037528; https://clinicaltrials.gov/ct2/show/NCT03037528 ",
doi="10.2196/44295",
url="https://diabetes.jmir.org/2023/1/e44295",
url="http://www.ncbi.nlm.nih.gov/pubmed/37166961"
}


@Article{info:doi/10.2196/38959,
author="Tham, Cong Xiang
and Whitton, Clare
and M{\"u}ller-Riemenschneider, Falk
and Petrunoff, Alexander Nicholas",
title="Young Adults' Use of Mobile Food Delivery Apps and the Potential Impacts on Diet During the COVID-19 Pandemic: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="9",
volume="7",
pages="e38959",
keywords="young adults",
keywords="food delivery",
keywords="mobile app",
keywords="COVID-19",
keywords="diet",
keywords="sugar-sweetened beverages",
keywords="mixed methods",
keywords="fruits",
keywords="vegetables",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. Objective: We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. Methods: A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Results: The quantitative results revealed that 41.7\% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. Conclusions: This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post--COVID-19 new normal on dietary patterns and physical activity levels. ",
doi="10.2196/38959",
url="https://formative.jmir.org/2023/1/e38959",
url="http://www.ncbi.nlm.nih.gov/pubmed/37018540"
}


@Article{info:doi/10.2196/41498,
author="Veldheer, Susan
and Whitehead-Zimmers, Maxfield
and Bordner, Candace
and Watt, Benjamin
and Conroy, E. David
and Schmitz, H. Kathryn
and Sciamanna, Christopher",
title="Participant Preferences for the Development of a Digitally Delivered Gardening Intervention to Improve Diet, Physical Activity, and Cardiovascular Health: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="2",
volume="7",
pages="e41498",
keywords="intervention development",
keywords="cardiovascular health",
keywords="gardening",
keywords="diet",
keywords="physical activity",
keywords="behavior change wheel",
abstract="Background: Low dietary intake of fruits and vegetables and physical inactivity are 2 modifiable risk factors for cardiovascular disease. Fruit and vegetable gardening can provide access to fresh produce, and many gardening activities are considered moderate physical activity. This makes gardening interventions a potential strategy for cardiovascular disease risk reduction. Previously developed gardening interventions have relied on in-person delivery models, which limit scalability and reach. Objective: The purpose of this study was to ascertain participant insight on intervention components and topics of interest to inform a digitally delivered, gardening-focused, multiple health behavior change intervention. Methods: A web-based survey was delivered via Amazon Mechanical Turk (MTurk), including quantitative and open-ended questions. Eligible participants were aged ?20 years, could read and write in English, were US residents, and had at least a 98\% MTurk task approval rating. A multilevel screening process was used to identify and exclude respondents with response inattention, poor language fluency, or suspected automated web robots (bots). Participants were asked about their interest in gardening programming, their preferences for intervention delivery modalities (1-hour expert lectures, a series of brief <5-minute videos, or in-person meetings), and what information is needed to teach new gardeners. Comparisons were made between never gardeners (NG) and ever gardeners (EG) in order to examine differences in perceptions based on prior experience. Quantitative data were summarized, and differences between groups were tested using chi-square tests. Qualitative data were coded and organized into intervention functions based on the Behavior Change Wheel. Results: A total of 465 participants were included (n=212, 45.6\% NG and n=253, 54.4\% EG). There was a high level of program interest overall (n=355, 76.3\%), though interest was higher in EG (142/212, 67\% NG; 213/253, 84.2\% EG; P<.001). The majority of participants (n=282, 60.7\%) preferred a series of brief <5-minute videos (136/212, 64.2\% NG; 146/253, 57.7\% EG; P=.16) over 1-hour lectures (29/212, 13.7\% NG; 50/253, 19.8\% EG; P=.08) or in-person delivery modes (47/212, 22.2\% NG; 57/253, 22.5\% EG; P=.93). Intervention functions identified were education and training (performing fundamental gardening and cooking activities), environmental restructuring (eg, social support), enablement (provision of tools or seeds), persuasion (offering encouragement and highlighting the benefits of gardening), and modeling (using content experts and participant testimonials). Content areas identified included the full lifecycle of gardening activities, from the fundamentals of preparing a garden site, planting and maintenance to harvesting and cooking. Conclusions: In a sample of potential web-based learners, participants were interested in a digitally delivered gardening program. They preferred brief videos for content delivery and suggested content topics that encompassed how to garden from planting to harvesting and cooking. The next step in this line of work is to identify target behavior change techniques and pilot test the intervention to assess participant acceptability and preliminary efficacy. ",
doi="10.2196/41498",
url="https://formative.jmir.org/2023/1/e41498",
url="http://www.ncbi.nlm.nih.gov/pubmed/37129952"
}


@Article{info:doi/10.2196/41926,
author="Zhang, Na
and Zhou, Mingzhu
and Li, Muxia
and Ma, Guansheng",
title="Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="28",
volume="25",
pages="e41926",
keywords="overweight and obesity",
keywords="remote interventions",
keywords="older population",
keywords="dietary intake",
keywords="physical activity",
keywords="weight management",
keywords="health",
keywords="mobile phone",
abstract="Background: Traditional health management requires many human and material resources and cannot meet the growing needs. Remote medical technology provides an opportunity for health management; however, the research on it is insufficient. Objective: The objective of this study was to assess the effects of remote interventions on weight management. Methods: In this randomized controlled study, 750 participants were randomly assigned to a remote dietary and physical activity intervention group (group DPI), remote physical activity intervention group (group PI), or control group (group C). At baseline (time 1), day 45 (time 2), and day 90 (time 3), data were collected, including data on dietary intake, physical activity, indexes related to weight control, and health benefits. Results: A total of 85.6\% (642/750) of participants completed the follow-up. Compared with group C, group DPI showed a significant decrease in energy intake (?581 vs ?82 kcal; P<.05), protein intake (?17 vs ?3 g; P<.05), fat intake (?8 vs 3 g; P<.05), and carbohydrate intake (?106.5 vs ?4.7 g; P<.05) at time 3. Compared with time 1, groups DPI and PI showed a significant decrease in cereal and potato intake (P<.05). Compared with time 1, the physical activity levels related to transportation (group PI: 693 vs 597 metabolic equivalent [MET]--min/week, group C: 693 vs 594 MET-min/week; P<.05) and housework and gardening (group PI: 11 vs 0 MET-min/week, group C: 11 vs 4 MET-min/week; P<.05) in groups PI and C were improved at time 3. Compared with groups PI and C, group DPI showed a significant decrease in weight (?1.56 vs ?0.86 kg and ?1.56 vs ?0.66 kg, respectively; P<.05) and BMI (?0.61 vs ?0.33 kg/m2 and ?0.61 vs ?0.27 kg/m2, respectively; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in body weight (?4.11 vs ?1.01 kg and ?4.11 vs ?0.83 kg, respectively; P<.05) and BMI (?1.61 vs ?0.40 kg/m2 and ?1.61 vs ?0.33 kg/m2, respectively; P<.05) at time 3. Compared with group C, group DPI showed a significant decrease in triglyceride (?0.06 vs 0.32 mmol/L; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in systolic blood pressure (?8.15 vs ?3.04 mmHg and ?8.15 vs ?3.80 mmHg, respectively; P<.05), triglyceride (?0.48 vs 0.11 mmol/L and ?0.48 vs 0.18 mmol/L, respectively; P<.05), and fasting blood glucose (?0.77 vs 0.43 mmol/L and ?0.77 vs 0.14 mmol/L, respectively; P<.05). There were significant differences in high-density lipoprotein cholesterol (?0.00 vs ?0.07 mmol/L; P<.05) and hemoglobin A1c (?0.19\% vs ?0.07\%; P<.05) between groups DPI and C. Conclusions: Remote dietary and physical activity interventions can improve dietary intake among participants with overweight and obesity, are beneficial for weight control, and have potential health benefits. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023355; https://www.chictr.org.cn/showproj.html?proj=38976 ",
doi="10.2196/41926",
url="https://www.jmir.org/2023/1/e41926",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115608"
}


@Article{info:doi/10.2196/38545,
author="Tugault-Lafleur, N. Claire
and De-Jongh Gonz{\'a}lez, Olivia
and Macdonald, Janice
and Bradbury, Jennifer
and Warshawski, Tom
and Ball, C. Geoff D.
and Morrison, Katherine
and Ho, Josephine
and Hamilton, Jill
and Buchholz, Annick
and M{\^a}sse, Louise",
title="Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="25",
volume="25",
pages="e38545",
keywords="mobile health",
keywords="mHealth",
keywords="childhood obesity",
keywords="lifestyle management",
keywords="adolescents",
keywords="randomized controlled trial",
keywords="RCT",
keywords="mobile phone",
abstract="Background: Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective: The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. Methods: A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. Results: A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. Conclusions: The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 ",
doi="10.2196/38545",
url="https://www.jmir.org/2023/1/e38545",
url="http://www.ncbi.nlm.nih.gov/pubmed/37097726"
}


@Article{info:doi/10.2196/36837,
author="Cox, S. Jennifer
and Hinton, C. Elanor
and Hamilton Shield, Julian
and Lawrence, S. Natalia",
title="An App-Based Intervention for Pediatric Weight Management: Pre-Post Acceptability and Feasibility Trial",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="24",
volume="7",
pages="e36837",
keywords="obesity",
keywords="pediatric",
keywords="intervention",
keywords="eHealth",
keywords="weight management",
abstract="Background: A multidisciplinary approach to weight management is offered at tier 3 pediatric weight management services in the United Kingdom. Encouraging dietary change is a major aim, with patients meeting with dieticians, endocrinologists, psychologists, nurse specialists, and social workers on average every other month. Objective: This research sought to trial an inhibitory control training smartphone app---FoodT---with the clinic population of a pediatric weight management service. FoodT has shown positive impacts on food choice in adult users, with resulting weight loss. It was hoped that when delivered as an adjunctive treatment alongside the extensive social, medical, psychological, and dietetic interventions already offered at the clinic, the introduction of inhibitory control training may offer patients another tool that supports eating choice. In this feasibility trial, recruitment, retention, and app use were the primary outcomes. An extensive battery of measures was included to test the feasibility and acceptability of these measures for future powered trials. Methods: FoodT was offered to pediatric patients and their parents during a routine clinic appointment, and patients were asked to use the app at home every day for the first week and once per week for the rest of the month. Feasibility and acceptability were measured in terms of recruitment, engagement with the app, and retention to the trial. A battery of psychometric tests was given before and after app use to assess the acceptability of collecting data on changes to food choices and experiences that would inform future trial work. Results: A total of 12 children and 10 parents consented (22/62, 35\% of those approached). Further, 1 child and no parents achieved the recommended training schedule. No participants completed the posttrial measures. The reasons for not wanting to be recruited to the trial included participants not considering their weight to be connected to eating choices and not feeling that the app suited their needs. No reasons are known for noncompletion. Conclusions: It is unclear whether the intervention itself or the research processes, including the battery of measures, prevented completion. It is therefore difficult to make any decisions as to the value that the app has within this setting. Important lessons have been learned from this research that have potential broad relevance, including the importance of co-designing interventions with service users and avoiding deterring people from early-stage participation in extensive data collection. ",
doi="10.2196/36837",
url="https://formative.jmir.org/2023/1/e36837",
url="http://www.ncbi.nlm.nih.gov/pubmed/37093633"
}


@Article{info:doi/10.2196/37515,
author="Chen, Elizabeth
and Bishop, Jared
and Guge Cozon, Lindsay
and Hernandez, Eduardo
and Sadeghzadeh, Claire
and Bradley, Megan
and Dearth-Wesley, Tracy
and De Marco, Molly",
title="Integrating Human-Centered Design Methods Into a Health Promotion Project: Supplemental Nutrition Assistance Program Education Case Study for Intervention Design",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="21",
volume="7",
pages="e37515",
keywords="human-centered design",
keywords="design thinking",
keywords="program development",
keywords="stakeholder engagement",
keywords="nutrition",
keywords="parenting",
keywords="children",
keywords="pediatrics",
abstract="Background: Human-centered design, or design thinking, offers an extensive toolkit of methods and strategies for user-centered engagement that lends itself well to intervention development and implementation. These methods can be applied to the fields of public health and medicine to design interventions that may be more feasible and viable in real-world contexts than those developed with different methods. Objective: The design team aimed to develop approaches to building food skills among caregivers of children aged 0-5 years who are eligible for a federal food assistance program while they were in the grocery store. Methods: They applied 3 specific human-centered design methods---Extremes and Mainstreams, Journey Mapping, and Co-Creation Sessions---to collaboratively develop intervention approaches to enhance Supplemental Nutrition Assistance Program Education (SNAP-Ed) reach and impact across food retail settings. Extremes and Mainstreams is a specific kind of purposive sampling that selects individuals based on characteristics beyond demographics. Journey Mapping is a visual tool that asks individuals to identify key moments and decision points during an experience. Co-Creation Sessions are choreographed opportunities for individuals to explicitly contribute to the design of a solution alongside research or design team members. Results: Ten caregivers with diverse lived experiences were selected to participate in remote design thinking workshops and create individual journey maps to depict their grocery store experiences. Common happy points and pain points were identified. Nine stakeholders, including caregivers, SNAP-Ed staff, and grocery store dieticians, cocreated 2 potential intervention approaches informed by caregivers' experiences and needs: a rewards program and a meal box option. Conclusions: These 3 human-centered design methods led to a meaningful co-design process where proposed interventions aligned with caregivers' wants and needs. This case study provides other public health practitioners with specific examples of how to use these methods in program development and stakeholder engagement as well as lessons learned when adapting these methods to remote settings. ",
doi="10.2196/37515",
url="https://formative.jmir.org/2023/1/e37515",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083485"
}


@Article{info:doi/10.2196/42432,
author="Chew, Jocelyn Han Shi
and Rajasegaran, Nicole Nagadarshini
and Chin, Han Yip
and Chew, Nicholas W. S.
and Kim, Mi Kyung",
title="Effectiveness of Combined Health Coaching and Self-Monitoring Apps on Weight-Related Outcomes in People With Overweight and Obesity: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="18",
volume="25",
pages="e42432",
keywords="apps",
keywords="BMI",
keywords="cardiometabolic",
keywords="database",
keywords="diet behaviour",
keywords="health coaching",
keywords="monitoring",
keywords="obesity",
keywords="physical activity",
keywords="waist circumference",
keywords="weight loss",
keywords="weight",
abstract="Background: Self-monitoring smartphone apps and health coaching have both individually been shown to improve weight-related outcomes, but their combined effects remain unclear. Objective: This study aims to examine the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in people with overweight and obesity. Methods: Relevant articles published from inception till June 9, 2022, were searched through 8 databases (Embase, CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, and Web of Science). Effect sizes were pooled using random-effects models. Behavioral strategies used were coded using the behavior change techniques taxonomy V1. Results: A total of 14 articles were included, representing 2478 participants with a mean age of 39.1 years and a BMI of 31.8 kg/m2. Using combined intervention significantly improved weight loss by 2.15 kg (95\% CI ?3.17 kg to ?1.12 kg; P<.001; I2=60.3\%), waist circumference by 2.48 cm (95\% CI ?3.51 cm to ?1.44 cm; P<.001; I2=29\%), triglyceride by 0.22 mg/dL (95\% CI ?0.33 mg/dL to 0.11 mg/dL; P=.008; I2=0\%), glycated hemoglobin by 0.12\% (95\% CI ?0.21 to ?0.02; P=.03; I2=0\%), and total calorie consumption per day by 128.30 kcal (95\% CI ?182.67 kcal to ?73.94 kcal; P=.003; I2=0\%) kcal, but not BMI, blood pressure, body fat percentage, cholesterol, and physical activity. Combined interventional effectiveness was superior to receiving usual care and apps for waist circumference but only superior to usual care for weight loss. Conclusions: Combined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app. Trial Registration: PROSPERO CRD42022345133; https://tinyurl.com/2zxfdpay ",
doi="10.2196/42432",
url="https://www.jmir.org/2023/1/e42432",
url="http://www.ncbi.nlm.nih.gov/pubmed/37071452"
}


@Article{info:doi/10.2196/45332,
author="Razavi, Rouzbeh
and Xue, Guisen",
title="Predicting Unreported Micronutrients From Food Labels: Machine Learning Approach",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="12",
volume="25",
pages="e45332",
keywords="micronutrient deficiencies",
keywords="micronutrient",
keywords="food label",
keywords="food",
keywords="nutrition",
keywords="nutrient",
keywords="diet",
keywords="machine learning",
keywords="algorithm",
keywords="predict",
keywords="predictive model",
keywords="nutrition mobile applications",
keywords="mobile app",
keywords="health app",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Micronutrient deficiencies represent a major global health issue, with over 2 billion individuals experiencing deficiencies in essential vitamins and minerals. Food labels provide consumers with information regarding the nutritional content of food items and have been identified as a potential tool for improving diets. However, due to governmental regulations and the physical limitations of the labels, food labels often lack comprehensive information about the vitamins and minerals present in foods. As a result, information about most of the micronutrients is absent from existing food labels. Objective: This paper aims to examine the possibility of using machine learning algorithms to predict unreported micronutrients such as vitamin A (retinol), vitamin C, vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6, vitamin B12, vitamin E (alpha-tocopherol), vitamin K, and minerals such as magnesium, zinc, phosphorus, selenium, manganese, and copper from nutrition information provided on existing food labels. If unreported micronutrients can be predicted with acceptable accuracies from existing food labels using machine learning predictive models, such models can be integrated into mobile apps to provide consumers with additional micronutrient information about foods and help them make more informed diet decisions. Methods: Data from the Food and Nutrient Database for Dietary Studies (FNDDS) data set, representing a total of 5624 foods, were used to train a diverse set of machine learning classification and regression algorithms to predict unreported vitamins and minerals from existing food label data. For each model, hyperparameters were adjusted, and the models were evaluated using repeated cross-validation to ensure that the reported results were not subject to overfitting. Results: According to the results, while predicting the exact quantity of vitamins and minerals is shown to be challenging, with regression R2 varying in a wide range from 0.28 (for magnesium) to 0.92 (for manganese), the classification models can accurately predict the category (``low,'' ``medium,'' or ``high'') level of all minerals and vitamins with accuracies exceeding 0.80. The highest classification accuracies for specific micronutrients are achieved for vitamin B12 (0.94) and phosphorus (0.94), while the lowest are for vitamin E (0.81) and selenium (0.83). Conclusions: This study demonstrates the feasibility of predicting unreported micronutrients from existing food labels using machine learning algorithms. The results show that the approach has the potential to significantly improve consumer knowledge about the micronutrient content of the foods they consume. Integrating these predictive models into mobile apps can enhance their accessibility and engagement with consumers. The implications of this research for public health are noteworthy, underscoring the potential of technology to augment consumers' understanding of the micronutrient content of their diets while also facilitating the tracking of food intake and providing personalized recommendations based on the micronutrient content and individual preferences. ",
doi="10.2196/45332",
url="https://www.jmir.org/2023/1/e45332",
url="http://www.ncbi.nlm.nih.gov/pubmed/37043261"
}


@Article{info:doi/10.2196/42529,
author="D{\"o}tsch, Andreas
and Merz, Benedikt
and Louis, Sandrine
and Krems, Carolin
and Herrmann, Maria
and D{\"o}rr, Claudia
and Watzl, Bernhard
and Bub, Achim
and Stra{\ss}burg, Andrea
and Engelbert, Katrin Ann",
title="Assessment of Energy and Nutrient Intake and the Intestinal Microbiome (ErNst Study): Protocol and Methods of a Cross-sectional Human Observational Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="7",
volume="12",
pages="e42529",
keywords="dietary assessment",
keywords="human observational study",
keywords="nutrient intake",
keywords="human intestinal microbiome",
keywords="biomarkers",
keywords="24-hour recall",
keywords="validity",
keywords="nutrition",
keywords="diet",
keywords="assessment",
keywords="food",
keywords="behavior",
abstract="Background: On the national level, nutritional monitoring requires the assessment of reliable representative dietary intake data. To achieve this, standardized tools need to be developed, validated, and kept up-to-date with recent developments in food products and the nutritional behavior of the population. Recently, the human intestinal microbiome has been identified as an essential mediator between nutrition and host health. Despite growing interest in this connection, only a few associations between the microbiome, nutrition, and health have been clearly established. Available studies paint an inconsistent picture, partly due to a lack of standardization. Objective: First, we aim to verify if food consumption, as well as energy and nutrient intake of the German population, can be recorded validly by means of the dietary recall software GloboDiet, which will be applied in the German National Nutrition Monitoring. Second, we aim to obtain high-quality data using standard methods on the microbiome, combined with dietary intake data and additional fecal sample material, and to also assess the functional activity of the microbiome by measuring microbial metabolites. Methods: Healthy female and male participants aged between 18 and 79 years were recruited. Anthropometric measurements included body height and weight, BMI, and bioelectrical impedance analysis. For validation of the GloboDiet software, current food consumption was assessed with a 24-hour recall. Nitrogen and potassium concentrations were measured from 24-hour urine collections to enable comparison with the intake of protein and potassium estimated by the GloboDiet software. Physical activity was measured over at least 24 hours using a wearable accelerometer to validate the estimated energy intake. Stool samples were collected in duplicate for a single time point and used for DNA isolation and subsequent amplification and sequencing of the 16S rRNA gene to determine microbiome composition. For the identification of associations between nutrition and the microbiome, the habitual diet was determined using a food frequency questionnaire covering 30 days. Results: In total, 117 participants met the inclusion criteria. The study population was equally distributed between the sexes and 3 age groups (18-39, 40-59, and 60-79 years). Stool samples accompanying habitual diet data (30-day food frequency questionnaire) are available for 106 participants. Current diet data and 24-hour urine samples for the validation of GloboDiet are available for 109 participants, of which 82 cases also include physical activity data. Conclusions: We completed the recruitment and sample collection of the ErNst study with a high degree of standardization. Samples and data will be used to validate the GloboDiet software for the German National Nutrition Monitoring and to compare microbiome composition and nutritional patterns. Trial Registration: German Register of Clinical Studies DRKS00015216; https://drks.de/search/de/trial/DRKS00015216 International Registered Report Identifier (IRRID): DERR1-10.2196/42529 ",
doi="10.2196/42529",
url="https://www.researchprotocols.org/2023/1/e42529",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027187"
}


@Article{info:doi/10.2196/38667,
author="Brusk, J. John
and Bensley, J. Robert",
title="COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="2",
volume="7",
pages="e38667",
keywords="COVID-19",
keywords="user engagement",
keywords="infodemic",
keywords="Women, Infants, and Children",
keywords="WIC",
keywords="educational resource",
keywords="health care",
keywords="digital health",
keywords="nutrition",
keywords="web-based education",
keywords="web-based nutrition",
keywords="pediatric",
keywords="parenting",
keywords="dashboard",
abstract="Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site's user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9\% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9\% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19--specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. ",
doi="10.2196/38667",
url="https://formative.jmir.org/2023/1/e38667",
url="http://www.ncbi.nlm.nih.gov/pubmed/36787232"
}


@Article{info:doi/10.2196/41443,
author="Fres{\'a}n, Uju{\'e}
and Bernard, Paquito
and Fabregues, Sergi
and Boronat, Anna
and Ara{\'u}jo-Soares, Vera
and K{\"o}nig, M. Laura
and Chevance, Guillaume",
title="A Smartphone Intervention to Promote a Sustainable Healthy Diet: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="2",
volume="12",
pages="e41443",
keywords="eating behavior change protocol",
keywords="sustainable diet",
keywords="dietary sustainability",
keywords="eating behavior change",
keywords="n-of-1",
keywords="nutritional education",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Changing current dietary patterns into sustainable healthy diets (ie, healthy diets with low environmental impact and socioeconomic fairness) is urgent. So far, few eating behavior change interventions have addressed all the dimensions of sustainable healthy diets at once and used cutting-edge methods from the field of digital health behavior change. Objective: The primary objectives of this pilot study were to assess the feasibility and effectiveness of an individual behavior change intervention toward the adoption of a more environmentally sustainable healthy diet as a whole and changes in specific relevant food groups, food waste, and obtaining food from fair sources. The secondary objectives included the identification of mechanisms of action that potentially mediate the effect of the intervention on behaviors, identification of potential spillover effects and covariations among different food outcomes, and identification of the role of socioeconomic status in behavior changes. Methods: We will run a series of ABA n-of-1 trials over a year, with the first A phase corresponding to a 2-week baseline evaluation, the B phase to a 22-week intervention, and the second A phase to a 24-week postintervention follow-up. We plan to enroll 21 participants from low, middle, and high socioeconomic statuses, with 7 from each socioeconomic group. The intervention will involve sending text messages and providing brief individualized web-based feedback sessions based on regular app-based assessments of eating behavior. The text messages will contain brief educational messages on human health and the environmental and socioeconomic effects of dietary choices; motivational messages to encourage the adoption of sustainable healthy diets by participants, providing tips to achieve their own behavioral goals; or links to recipes. Both quantitative and qualitative data will be collected. Quantitative data (eg, on eating behaviors and motivation) will be collected through self-reported questionnaires on several weekly bursts spread through the study. Qualitative data will be collected through 3 individual semistructured interviews before the intervention period, at the end of the intervention period, and at the end of the study. Analyses will be performed at both the individual and group levels depending on the outcome and objective. Results: The first participants were recruited in October 2022. The final results are expected by October 2023. Conclusions: The results of this pilot study will be useful for designing future larger interventions on individual behavior change for sustainable healthy diets. International Registered Report Identifier (IRRID): PRR1-10.2196/41443 ",
doi="10.2196/41443",
url="https://www.researchprotocols.org/2023/1/e41443",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862497"
}


@Article{info:doi/10.2196/40506,
author="Voss, Claire
and Liu, Jianyi
and Chang, Angela
and Kosmas, A. Jacqueline
and Biehl, Abigail
and Flynn, L. Rebecca
and Kruzan, P. Kaylee
and Wildes, E. Jennifer
and Graham, K. Andrea",
title="Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="28",
volume="7",
pages="e40506",
keywords="binge eating",
keywords="weight loss expectations",
keywords="overvaluation of weight and shape",
keywords="digital intervention",
keywords="human-centered design",
keywords="weight loss",
keywords="user expectations",
keywords="behavioral change",
keywords="eating disorder",
keywords="obesity",
keywords="overweight",
abstract="Background: People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. Objective: The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. Methods: A total of 760 adults (n=504, 66\% female; n=441, 58\% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. Results: Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. Conclusions: In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention. ",
doi="10.2196/40506",
url="https://formative.jmir.org/2023/1/e40506",
url="http://www.ncbi.nlm.nih.gov/pubmed/36853750"
}


@Article{info:doi/10.2196/41636,
author="Al-Shami, Islam
and Al Hourani, Huda
and Alkhatib, Buthaina
and Alboqai, Omar
and AlHalaika, Dima
and Al-Jawaldeh, Ayoub",
title="Jordan's Population-Based Food Consumption Survey: Protocol for Design and Development",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="17",
volume="12",
pages="e41636",
keywords="household",
keywords="food consumption",
keywords="24-hour dietary recall",
keywords="children",
keywords="adolescents",
keywords="adults",
keywords="older adults",
keywords="overweight",
keywords="obesity",
abstract="Background: One of the factors influencing health and well-being is dietary patterns. Data on food consumption are necessary for evaluating and developing community nutrition policies. Few studies on Jordanians' food consumption and dietary habits at various ages have been conducted, despite the increased prevalence of overweight, obesity, and chronic diseases. This will be the first study focusing on Jordanians' food consumption patterns that includes children, adolescents, adults, and older adults. Objective: This cross-sectional study aims to describe the design and methodology of the Jordan's Population-based Food Consumption Survey, 2021-2022, which was developed to collect data on food consumption, including energy, nutrients, and food group intake, from a representative sample of Jordanians and to determine the prevalence of overweight and obesity and their relationship to food consumption. Methods: Participants were selected by stratified random sampling, using the Estimated Population of the Kingdom by Governorate, Locality, Sex, and Households, 2020 as the sampling frame. The food consumption survey sample was at the population level, representing gender and age classes (8-85 years old). The data collection period was 6 months. Food consumption was assessed using 24-hour dietary recall (2 nonconsecutive days, 1 week apart) interviews representing weekdays and weekends. In addition to data on food consumption, information on the use of food supplements, sociodemographic and socioeconomic status, and health was gathered. Weight, height, and waist circumference were all measured. Results: The survey included 632 households with 2145 participants, of which 243 (11.3\%) were children, 374 (17.4\%) were adolescents, 1428 (66.6\%) were adults, and 99 (4.6\%) were older adults. Three food consumption databases were used to stratify the mean 24-hour dietary recall food consumption into energy intake, carbohydrates, proteins, fats, fiber, vitamins and minerals, and food groups. BMI was calculated and classified as normal, overweight, or obese. Central obesity was classified as normal or abnormal based on the waist-to-height ratio. The survey results will be disseminated based on age, energy, nutrient, and food group consumption. The prevalence of overweight and obesity by age group will be presented, as well as a comparison to the situation in Eastern Mediterranean countries. Conclusions: The survey data will be helpful in nutritional studies, assessing changes in dietary patterns, and developing and evaluating nutrition or health policies. It will be a solid base for developing a future national surveillance system on food consumption patterns with comprehensive food consumption, physical activity, biochemical, and blood pressure data. International Registered Report Identifier (IRRID): DERR1-10.2196/41636 ",
doi="10.2196/41636",
url="https://www.researchprotocols.org/2023/1/e41636",
url="http://www.ncbi.nlm.nih.gov/pubmed/36800239"
}


@Article{info:doi/10.2196/44456,
author="Chiarello, Indira Delia
and Pardo, Fabian
and Moya, Jessica
and Pino, Maricela
and Rodr{\'i}guez, Andrea
and Araneda, Eugenia Mar{\'i}a
and Bertini, Ayleen
and Guti{\'e}rrez, Jaime",
title="An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="15",
volume="12",
pages="e44456",
keywords="gestational obesity",
keywords="mHealth",
keywords="primary care",
keywords="randomized controlled trial",
abstract="Background: The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak. Objective: This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers. Methods: The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome. Results: The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women. Conclusions: Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care. Trial Registration: ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174 International Registered Report Identifier (IRRID): DERR1-10.2196/44456 ",
doi="10.2196/44456",
url="https://www.researchprotocols.org/2023/1/e44456",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790846"
}


@Article{info:doi/10.2196/42496,
author="Omar, Noraida
and Shafiee, Illyani Shazli
and Nor'hisham, Hazimah Siti
and Ibrahim, Zuriati
and Jamaluddin, Rosita
and Rahamat, Syafiqah
and Mohd Yusof, Nisak Barakatun
and Minhat, Sakdiah Halimatus
and Sallehuddin, Hakimah
and Mazlan, Syazwani Nur",
title="A Logical Framework (MYGERYFS) for Hospital Foodservice to Prevent Malnutrition Among Geriatric Patients in Hospitals, Malaysia: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="31",
volume="12",
pages="e42496",
keywords="hospital foodservice satisfaction",
keywords="hospital meals satisfaction",
keywords="elderly",
keywords="nutrition",
keywords="malnutrition in elderly",
keywords="malnutrition",
keywords="geriatric",
keywords="patient",
keywords="prevention",
keywords="nutrient",
keywords="feasibility",
abstract="Background: Geriatric malnutrition in hospitals is common and can be affected by many things, including poor satisfaction toward hospital foodservice. Hospital foodservice plays an important role in a patient's recovery process by providing adequate nutrients. On top of that, patients' foodservice satisfaction can easily be afflicted by the quality of food served and the overall foodservice experience. Furthermore, malnutrition can occur from poor foodservice quality, especially among geriatric patients. Objective: This study aims to assess the effectiveness of the Malaysian Geriatric Patients' Hospital Foodservice Protocol (MYGERYFS). Methods: The protocol comprises 3 phases. Phase One is a cross-sectional study that took place at public hospitals with geriatric wards in the Klang Valley. Univariate data from Phase One were analyzed descriptively. Pearson correlation and chi-square were conducted to find factors associated with foodservice satisfaction. Phase Two involves the collaboration of health care professionals in the geriatric field. In Phase Three, a feasibility study will be conducted to determine the feasibility of the MYGERYFS protocol in a hospital among 60 geriatric patients. These patients will be randomized into control and intervention groups, respectively. Intervention care will be done to ensure the safety of the protocol. Results: Data collection for Phase One of the study has been completed. A total of 233 geriatric respondents with the mean age of 71.39 (SD 7.99) years were gathered. Approximately 51.5\% (n=120) of the respondents were female, while 48.5\% (n=113) were male, with a mean BMI of 24.84 (SD 6.05) kg/m2. Their mean energy and protein intakes were 1006.20 kcal (SD 462.03 kcal) and 42.60 (SD 22.20) grams, respectively. Based on the Mini Nutritional Assessment, older patients who scored 12-14 (normal) were 27.9\% (n=65), those who scored 8-11 (at risk) were 54.9\% (n=128), and those who scored 0-7, which is the lowest (malnutrition), were 17.2\% (n=40) of the study population. Hence, most patients were at risk of malnutrition. Although a majority of the patients claimed to have good foodservice satisfaction 26.2\% (n=61), they also experienced at least 3 barriers during mealtimes. It was found that dietary intake and mealtime barriers were significantly associated with the respondent's foodservice satisfaction. Data for Phase Two and Phase Three are yet to be collected and analyzed. Conclusions: This study protocol could potentially benefit the hospital foodservice system and aid in improving geriatric nutritional status. Trial Registration: ClinicalTrials.gov NCT04858165; https://clinicaltrials.gov/ct2/show/NCT04858165 International Registered Report Identifier (IRRID): RR1-10.2196/42496 ",
doi="10.2196/42496",
url="https://www.researchprotocols.org/2023/1/e42496",
url="http://www.ncbi.nlm.nih.gov/pubmed/36719732"
}


@Article{info:doi/10.2196/38378,
author="Koeryaman, Trisyani Mira
and Pallikadavath, Saseendran
and Ryder, Helen Isobel
and Kandala, Ngianga",
title="The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="30",
volume="7",
pages="e38378",
keywords="web-based application",
keywords="nutrition",
keywords="pregnant women",
keywords="pregnancy",
keywords="mobile app",
keywords="diet",
keywords="dietary intake",
keywords="application",
keywords="Indonesia",
keywords="randomized controlled trial",
keywords="tool",
keywords="consumption",
keywords="maternal",
keywords="weight",
keywords="weight gain",
keywords="intervention",
keywords="control group",
keywords="treatment",
keywords="vitamins",
keywords="minerals",
keywords="healthy diet",
keywords="calorie",
keywords="food",
abstract="Background: Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. Objective: The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. Methods: ?First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. Results: The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95\% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95\% CI 114.52-199.23; d=--1.39; P=.002), 102.43 g of carbohydrates (95\% CI --125.2 to --79.60; d=--1.68; P=.02), 14.33 g of protein (95\% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95\% CI --13.71 to --8.20; d=--1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. Conclusions: ?Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. Trial Registration: ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828 ",
doi="10.2196/38378",
url="https://formative.jmir.org/2023/1/e38378",
url="http://www.ncbi.nlm.nih.gov/pubmed/36716078"
}


@Article{info:doi/10.2196/41837,
author="Hellner, Megan
and Steinberg, Dori
and Baker, H. Jessica
and Blanton, Camilla",
title="Digitally Delivered Dietary Interventions for Patients with Eating Disorders Undergoing Family-Based Treatment: Protocol for a Randomized Feasibility Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="26",
volume="12",
pages="e41837",
keywords="eating disorders",
keywords="virtual treatment",
keywords="dietary interventions",
keywords="family-based treatment",
keywords="anorexia",
keywords="psychiatric disorder",
keywords="digital health intervention",
keywords="telehealth",
keywords="virtual health",
abstract="Background: Eating disorders (EDs) affect 9\% of the United States population, and anorexia nervosa (AN), specifically, has the second highest mortality rate of all psychiatric disorders. Yet, only 20\% are able to access treatment. Access to care issues include long waitlists, lack of trained specialists, financial, and geographic barriers, all of which highlight the need for effective telehealth interventions. Family-based therapy (FBT) is a first-line treatment for adolescents and young adults with EDs, and weight gain early in treatment is considered a primary predictor of success with FBT. However, nutrition requirements for patients with EDs are uniquely complex. A variety of dietary interventions for guiding the renourishment process are used in practice, but empirical data on the effectiveness and acceptability of the various interventions are sparse. The significance of nutritional restoration and issues with access to first-line treatments underscore the need for further research exploring virtually delivered dietary interventions. Objective: Our objective is to compare the effectiveness and acceptability of 2 digitally delivered dietary interventions frequently used in eating disorder treatment settings: (1) calorie-based meal plans and (2) the Plate-by-Plate approach. Specifically, we will explore any potential differences in weight restoration achieved over 8 weeks of treatment as a primary measure of effectiveness, as well as additional treatment outcomes (ED symptoms, anxiety, depression, caregiver burden, and perceived effectiveness and acceptability for both caregivers and clinicians). Methods: Patients (N=100) with either AN or avoidant restrictive food intake disorders (ARFID) aged 6-24 years seeking treatment at a nationwide virtual eating disorder treatment program, were enrolled between May and August 2022. Upon admission, patients were randomly assigned to receive either the calorie-based intervention or Plate-by-Plate approach from their registered dietitian, all of whom have received training as study interventionists. While we were primarily interested in responses during the first 8 weeks of treatment, patients will be followed for up to 12 months. Descriptive statistics were used to describe patient characteristics and demographics. Weight changes and other treatment outcomes between groups will be compared using generalized linear models. Semistructured caregiver and clinician interview transcripts will undergo qualitative analysis. Results: Enrollment ran from March to August 2022, and we anticipate completion of data collection by November 2022. Analyses will be completed in January 2023. Conclusions: This study contributes to existing FBT literature by thoroughly exploring the acceptability of dietary interventions and their influence on weight restoration, an area in which research is sparse. International Registered Report Identifier (IRRID): DERR1-10.2196/41837 ",
doi="10.2196/41837",
url="https://www.researchprotocols.org/2023/1/e41837",
url="http://www.ncbi.nlm.nih.gov/pubmed/36701182"
}


@Article{info:doi/10.2196/42266,
author="Valinskas, Sarunas
and Nakrys, Marius
and Aleknavi{\v c}ius, Kasparas
and Jonusas, Justinas
and Lileikien?, Angel?",
title="User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="24",
volume="7",
pages="e42266",
keywords="intermittent fasting",
keywords="fasting",
keywords="weight",
keywords="weight loss",
keywords="mobile application",
keywords="body composition",
keywords="mHealth",
keywords="mobile health",
keywords="diet",
keywords="dietary intervention",
keywords="weight loss outcome",
keywords="adherence",
keywords="engagement",
keywords="mobile app",
keywords="motivation",
keywords="intervention outcome",
keywords="fasting apps",
keywords="dietary interventions",
keywords="obesity",
keywords="regression analysis",
abstract="Background: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. Objective: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. Methods: We performed a retrospective analysis of data from 665 users with obesity (BMI?30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in \%), and body muscle (in \%) were compared. Results: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. Conclusions: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass. ",
doi="10.2196/42266",
url="https://formative.jmir.org/2023/1/e42266",
url="http://www.ncbi.nlm.nih.gov/pubmed/36692936"
}


@Article{info:doi/10.2196/40062,
author="Horn, Bade Deborah
and Pash, Elizabeth
and Zhou, S. Megan
and Broffman, Lauren
and Bialonczyk, Damian
and Doron, Tzvi
and Chiquette, Elaine",
title="Characteristics and Weight Loss Practices From a Cohort of 20,000 Patients Using Direct-to-Consumer Telehealth: Observational Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="5",
volume="7",
pages="e40062",
keywords="obesity",
keywords="preobesity",
keywords="overweight",
keywords="weight management",
keywords="direct-to-consumer telehealth",
keywords="oral superabsorbent hydrogel",
abstract="Background: Despite the increasing prevalence of obesity, the use of pharmacotherapy treatment remains low. Telehealth platforms have the potential to facilitate access to pharmacotherapy interventions, but little is known about telehealth patients. Objective: This study describes a large patient population taking Plenity, an oral superabsorbent hydrogel (OSH) used in the treatment of excess weight or obesity (BMI 25-40 kg/m2). The analysis compared differences in weight loss practices and in-person access to obesity care among telehealth patients with preobesity and obesity. Methods: This was a cross-sectional assessment of a random sample of 20,000 telehealth patients who completed a structured, web-based visit and received at least one prescription of OSH. Patients were eligible to receive care via telehealth if they were adults, were not pregnant, and had a BMI ?25 kg/m2. During the visit, patients provided baseline health information including comorbidities, diet, and exercise habits. Their zip code of residence was used to determine their proximity to an obesity medicine provider. Descriptive statistical analysis and tests of differences (chi-square and 2-tailed t tests) were used to compare patients with preobesity (BMI 25-29.9 kg/m2) and obesity (BMI 30-40 kg/m2). Results: Most (15,576/20,000, 77.88\%) of the cohort were female, with a mean age of 44 (SD 11) years and a mean BMI of 32.4 (SD 4.1) kg/m2. Among the cohort, 32.13\% (6426/20,000) had preobesity, and 40.18\% (8036/20,000) of all patients had ?1 weight-related comorbidity. Almost all (19,732/20,000, 98.66\%) patients attempted 1 weight loss method before OSH and half (10,067/20,000, 50.34\%) tried ?4 different methods. Exercise and low-calorie diets were the most attempted weight loss methods, and 28.76\% (5752/20,000) of patients reported a prior prescription of weight loss medication. Patients with obesity were more likely than patients with preobesity to have previously tried commercial weight loss plans (7294/13,574, 53.74\% vs 2791/6426, 43.43\%; P<.001), specialized diets (8493/13,574, 62.57\% vs 3799/6426, 59.12\%; P<.001), over-the-counter supplements (6807/13,574, 50.15\% vs 2876/6426, 44.76\%; P<.001), and prescription weight loss medications (4407/13,574, 32.47\% vs 1345/6426, 20.93\%; P<.001). Females were more likely to seek treatment for preobesity (5332/15,576, 34.23\% vs 1094/4424, 24.73\% male; P<.001) and reported fewer comorbidities (5992/15,576, 38.47\% vs 2044/4424, 46.2\% male; P<.001), despite >90\% of both sexes reporting the belief that excess weight negatively affected their health (14,247/15,576, 91.47\% female participants, 4116/4424, 93.04\% male participants). Moreover, 29.25\% (5850/20,000) of patients lived in the same zip code and 85.15\% (17,030/20,000) lived in the same county as an obesity medicine provider. Conclusions: Data from this large patient cohort supports the potential for telehealth to provide prescriptive weight management treatment to a population seeking care. Patients with preobesity are an undertreated population who actively seek new weight management options. Female participants sought weight management treatment earlier in the disease continuum than males, despite reporting fewer comorbidities. ",
doi="10.2196/40062",
url="https://formative.jmir.org/2023/1/e40062",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602855"
}


@Article{info:doi/10.2196/37429,
author="Karimi, Nazgol
and Opie, Rachelle
and Crawford, David
and O'Connell, Stella
and Hamblin, Shane Peter
and Steele, Cheryl
and Ball, Kylie",
title="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",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="4",
volume="7",
pages="e37429",
keywords="type 2 diabetes",
keywords="healthy eating",
keywords="diet",
keywords="dietary intervention",
keywords="low socioeconomic position",
keywords="digitally delivered",
keywords="mobile health",
keywords="mHealth",
keywords="website",
keywords="mobile phone",
keywords="SMS text message",
keywords="qualitative descriptive",
abstract="Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. International Registered Report Identifier (IRRID): RR2-10.2196/19488 ",
doi="10.2196/37429",
url="https://formative.jmir.org/2023/1/e37429",
url="http://www.ncbi.nlm.nih.gov/pubmed/36598815"
}


@Article{info:doi/10.2196/38479,
author="Juarascio, S. Adrienne
and Srivastava, Paakhi
and Presseller, K. Emily
and Lin, Mandy
and Patarinski, G. Anna G.
and Manasse, M. Stephanie
and Forman, M. Evan",
title="Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="14",
volume="6",
number="12",
pages="e38479",
keywords="binge eating",
keywords="loss-of-control eating",
keywords="continuous glucose monitoring",
keywords="mobile phone",
abstract="Background: Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. Objective: This study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). Methods: Participants (N=30) were individuals with BED or BN engaging in ?3 episodes of ?5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. Results: Retention was high (25/30, 83\% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4\% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. Conclusions: This study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. Trial Registration: ClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT04126694 ",
doi="10.2196/38479",
url="https://formative.jmir.org/2022/12/e38479",
url="http://www.ncbi.nlm.nih.gov/pubmed/36515992"
}


@Article{info:doi/10.2196/39340,
author="Li, Chuqin
and Jordan, Alexis
and Song, Jun
and Ge, Yaorong
and Park, Albert",
title="A Novel Approach to Characterize State-level Food Environment and Predict Obesity Rate Using Social Media Data: Correlational Study",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="13",
volume="24",
number="12",
pages="e39340",
keywords="obesity",
keywords="social media",
keywords="machine learning",
keywords="lifestyle",
keywords="environment",
keywords="food",
keywords="correlation",
keywords="modeling",
keywords="predict",
keywords="rates",
keywords="outcome",
keywords="category",
keywords="dishes",
keywords="popular",
keywords="mobile phone",
abstract="Background: Community obesity outcomes can reflect the food environment to which the community belongs. Recent studies have suggested that the local food environment can be measured by the degree of food accessibility, and survey data are normally used to calculate food accessibility. However, compared with survey data, social media data are organic, continuously updated, and cheaper to collect. Objective: The objective of our study was to use publicly available social media data to learn the relationship between food environment and obesity rates at the state level. Methods: To characterize the caloric information of the local food environment, we used food categories from Yelp and collected caloric information from MyFitnessPal for each category based on their popular dishes. We then calculated the average calories for each category and created a weighted score for each state. We also calculated 2 other dimensions from the concept of access, acceptability and affordability, to build obesity prediction models. Results: The local food environment characterized using only publicly available social media data had a statistically significant correlation with the state obesity rate. We achieved a Pearson correlation of 0.796 between the predicted obesity rate and the reported obesity rate from the Behavioral Risk Factor Surveillance System across US states and the District of Columbia. The model with 3 generated feature sets achieved the best performance. Conclusions: Our study proposed a method for characterizing state-level food environments only using continuously updated social media data. State-level food environments were accurately described using social media data, and the model also showed a disparity in the available food between states with different obesity rates. The proposed method should elastically apply to local food environments of different sizes and predict obesity rates effectively. ",
doi="10.2196/39340",
url="https://www.jmir.org/2022/12/e39340",
url="http://www.ncbi.nlm.nih.gov/pubmed/36512396"
}


@Article{info:doi/10.2196/42191,
author="Patel, L. Michele
and Cleare, E. Angel
and Smith, M. Carly
and Rosas, Goldman Lisa
and King, C. Abby",
title="Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="13",
volume="6",
number="12",
pages="e42191",
keywords="weight loss",
keywords="obesity",
keywords="behavioral intervention",
keywords="self-monitoring",
keywords="race",
keywords="ethnicity",
keywords="digital health",
keywords="diet tracking",
keywords="engagement",
keywords="randomized controlled trial",
keywords="RCT",
keywords="mobile phone",
abstract="Background: Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. Objective: In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. Methods: We recruited racial and ethnic minority adults aged ?21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively. Results: The eligibility screen was completed by 248 individuals, of whom 38 (15.3\%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58\%) were identified as Hispanic of any race. The study retention rate was 92\% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49\% of days for detailed, 97\% for simplified; self-monitoring steps: 99\% for detailed, 100\% for simplified; self-monitoring weight: 67\% for detailed, 80\% for simplified). Participants in both arms reported high satisfaction, with 89\% indicating that they would recommend the intervention. Weight change was ?3.4 (95\% CI ?4.6 to ?2.2) kg for detailed and ?3.3 (95\% CI ?4.4 to ?2.2) kg for simplified. Conclusions: A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. Trial Registration: ASPREDICTED \#66674; https://aspredicted.org/ka478.pdf ",
doi="10.2196/42191",
url="https://formative.jmir.org/2022/12/e42191",
url="http://www.ncbi.nlm.nih.gov/pubmed/36512404"
}


@Article{info:doi/10.2196/42923,
author="Miller, Kamilla
and Jerome, J. Gerald",
title="Self-Monitoring Physical Activity, Diet, and Weight Among Adults Who Are Legally Blind: Exploratory Investigation",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Dec",
day="12",
volume="9",
number="4",
pages="e42923",
keywords="blindness",
keywords="visually impaired",
keywords="obesity",
keywords="weight loss",
keywords="weight management",
keywords="physical activity",
keywords="digital health intervention",
keywords="telehealth",
keywords="health support",
keywords="mobile phone",
abstract="Background: Obesity is a global pandemic. Lifestyle approaches have been shown effective for weight loss and weight loss maintenance. Central to these evidence-based approaches are increased physical activity, decreased caloric intake, regular self-weighing, and the tracking of these behaviors. Objective: This exploratory descriptive study surveyed adults who are legally blind to identify strategies related to tracking physical activity, diet, and weight. These health behaviors are essential components to evidence-based weight loss programs. We also identified areas where we can better support adults who are legally blind in their independent efforts to change these behaviors and improve their health. Methods: Participants (?18 years of age) who self-identified as being legally blind were recruited using email announcements in low vision advocacy groups. They completed an interviewer-administered survey on the telephone and an in-person visit for standardized assessment of height and weight. Results: The participants (N=18) had an average age of 31.2 (SD 13.4) years; 50\% (9/18) had normal weight (BMI 18.5 to <25); 44\% (8/18) were female; 44\% (8/18) were Black; and 39\% (7/18) were Non-Hispanic White. Most participants (16/18, 89\%) used their smartphone to access the internet daily, and 67\% (12/18) had at least 150 mins of exercise per week. Although 78\% (14/18) of the participants indicated tracking their weight, only 61\% (11/18) could indicate how they tracked their weight, and 22\% (4/18) indicated they tracked it mentally. Providing individuals with a talking scale was the most consistent recommendation (12/18, 67\%) to facilitate independence in managing weight through lifestyle changes. Even though 50\% (9/18) of the participants indicated using an app or electronic notes to track some portion of their diet, participants reported challenges with determining portion size and corresponding calorie counts. Most participants (17/18, 94\%) reported using apps, electronic notes, smartphones, or wearable devices to track their physical activity. Although strategies such as using wearables and smartphones could provide measurements (eg, step counts) as well as recording data, they also pose financial and technology literacy barriers. Conclusions: Technology-based solutions were identified for tracking weight, diet, and physical activity for weight management. These strategies have financial and technology literacy barriers. A range of strategies for adopting and tracking health behaviors will be needed to assist individuals with varying skills and life experiences. ",
doi="10.2196/42923",
url="https://rehab.jmir.org/2022/4/e42923",
url="http://www.ncbi.nlm.nih.gov/pubmed/36508250"
}


@Article{info:doi/10.2196/36585,
author="B{\"a}lter, Katarina
and Javan Abraham, Feben
and Mutimukwe, Chantal
and Mugisha, Reuben
and Persson Osowski, Christine
and B{\"a}lter, Olle",
title="A Web-Based Program About Sustainable Development Goals Focusing on Digital Learning, Digital Health Literacy, and Nutrition for Professional Development in Ethiopia and Rwanda: Development of a Pedagogical Method",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="5",
volume="6",
number="12",
pages="e36585",
keywords="digital learning",
keywords="digital health literacy",
keywords="sustainable development goals",
keywords="public health",
keywords="nutrition",
keywords="question-based learning",
keywords="open learning initiative",
keywords="Rwanda",
keywords="Ethiopia",
abstract="Background: East African countries face significant societal challenges related to sustainable development goals but have limited resources to address these problems, including a shortage of nutrition experts and health care workers, limited access to physical and digital infrastructure, and a shortage of advanced educational programs and continuing professional development. Objective: This study aimed to develop a web-based program for sustainable development with a focus on digital learning, digital health literacy, and child nutrition, targeting government officials and decision-makers at nongovernmental organizations (NGOs) in Ethiopia and Rwanda. Methods: A web-based program---OneLearns (Online Education for Leaders in Nutrition and Sustainability)---uses a question-based learning methodology. This is a research-based pedagogical method developed within the open learning initiative at Carnegie Mellon University, United States. Participants were recruited during the fall of 2020 from ministries of health, education, and agriculture and NGOs that have public health, nutrition, and education in their missions. The program was conducted during the spring of 2021. Results: Of the 70 applicants, 25 (36\%) were selected and remained active throughout the entire program and filled out a pre- and postassessment questionnaire. After the program, of the 25 applicants, 20 (80\%, 95\% CI 64\%-96\%) participants reported that their capacity to drive change related to the sustainable development goals as well as child nutrition in their organizations had increased to large extent or to a very large extent. Furthermore, 17 (68\%, 95\% CI 50\%-86\%) and 18 (72\%, 95\% CI 54\%-90\%) participants reported that their capacity to drive change related to digital health literacy and digital learning had increased to a large extent and to a very large extent, respectively. Conclusions: Digital learning based on a question-based learning methodology was perceived as a useful method for increasing the capacity to drive change regarding sustainable development among government officials and decision-makers at NGOs in Ethiopia and Rwanda. ",
doi="10.2196/36585",
url="https://formative.jmir.org/2022/12/e36585",
url="http://www.ncbi.nlm.nih.gov/pubmed/36469416"
}


@Article{info:doi/10.2196/40123,
author="Hermsen, Sander
and van Kraaij, Alex
and Camps, Guido",
title="Low-- and Medium--Socioeconomic-Status Group Members' Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study",
journal="JMIR Hum Factors",
year="2022",
month="Dec",
day="2",
volume="9",
number="4",
pages="e40123",
keywords="nutrition",
keywords="citizen science",
keywords="socioeconomic status",
keywords="digital technology",
abstract="Background: Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users' needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating. Objective: This study aimed to gather insights into people's thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains. Methods: Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach. Results: A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants. Conclusions: This study shows that people from low-- and medium--socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this. ",
doi="10.2196/40123",
url="https://humanfactors.jmir.org/2022/4/e40123",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459403"
}


@Article{info:doi/10.2196/40449,
author="Moyen, Audrey
and Rappaport, Ilysse Aviva
and Fleurent-Gr{\'e}goire, Chlo{\'e}
and Tessier, Anne-Julie
and Brazeau, Anne-Sophie
and Chevalier, St{\'e}phanie",
title="Relative Validation of an Artificial Intelligence--Enhanced, Image-Assisted Mobile App for Dietary Assessment in Adults: Randomized Crossover Study",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="21",
volume="24",
number="11",
pages="e40449",
keywords="dietary intake",
keywords="dietary assessment",
keywords="food diary",
keywords="food records",
keywords="automated self-administered 24-hour recall",
keywords="ASA24",
keywords="Keenoa",
abstract="Background: Thorough dietary assessment is essential to obtain accurate food and nutrient intake data yet challenging because of the limitations of current methods. Image-based methods may decrease energy underreporting and increase the validity of self-reported dietary intake. Keenoa is an image-assisted food diary that integrates artificial intelligence food recognition. We hypothesized that Keenoa is as valid for dietary assessment as the automated self-administered 24-hour recall (ASA24)--Canada and better appreciated by users. Objective: We aimed to evaluate the relative validity of Keenoa against a 24-hour validated web-based food recall platform (ASA24) in both healthy individuals and those living with diabetes. Secondary objectives were to compare the proportion of under- and overreporters between tools and to assess the user's appreciation of the tools. Methods: We used a randomized crossover design, and participants completed 4 days of Keenoa food tracking and 4 days of ASA24 food recalls. The System Usability Scale was used to assess perceived ease of use. Differences in reported intakes were analyzed using 2-tailed paired t tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman coefficient. Agreement and bias were determined using the Bland-Altman test. Weighted Cohen $\kappa$ was used for cross-classification analysis. Energy underreporting was defined as a ratio of reported energy intake to estimated resting energy expenditure <0.9. Results: A total of 136 participants were included (mean 46.1, SD 14.6 years; 49/136, 36\% men; 31/136, 22.8\% with diabetes). The average reported energy intakes (kcal/d) were 2171 (SD 553) in men with Keenoa and 2118 (SD 566) in men with ASA24 (P=.38) and, in women, 1804 (SD 404) with Keenoa and 1784 (SD 389) with ASA24 (P=.61). The overall mean difference (kcal/d) was ?32 (95\% CI ?97 to 33), with limits of agreement of ?789 to 725, indicating acceptable agreement between tools without bias. Mean reported macronutrient, calcium, potassium, and folate intakes did not significantly differ between tools. Reported fiber and iron intakes were higher, and sodium intake lower, with Keenoa than ASA24. Intakes in all macronutrients (r=0.48-0.73) and micronutrients analyzed (r=0.40-0.74) were correlated (all P<.05) between tools. Weighted Cohen $\kappa$ scores ranged from 0.30 to 0.52 (all P<.001). The underreporting rate was 8.8\% (12/136) with both tools. Mean System Usability Scale scores were higher for Keenoa than ASA24 (77/100, 77\% vs 53/100, 53\%; P<.001); 74.8\% (101/135) of participants preferred Keenoa. Conclusions: The Keenoa app showed moderate to strong relative validity against ASA24 for energy, macronutrient, and most micronutrient intakes analyzed in healthy adults and those with diabetes. Keenoa is a new, alternative tool that may facilitate the work of dietitians and nutrition researchers. The perceived ease of use may improve food-tracking adherence over longer periods. ",
doi="10.2196/40449",
url="https://www.jmir.org/2022/11/e40449",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409539"
}


@Article{info:doi/10.2196/35933,
author="Henriksen, Berg Hege
and Knudsen, Dines Markus
and Carlsen, Hauger Monica
and Hjart{\aa}ker, Anette
and Blomhoff, Rune",
title="A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e35933",
keywords="digital assessment tool",
keywords="assessment tool",
keywords="food frequency questionnaire",
keywords="food",
keywords="diet",
keywords="nutrition",
keywords="questionnaire",
keywords="focus group",
keywords="interview",
keywords="usability",
keywords="physical activity",
keywords="lifestyle factor",
keywords="dietary intake",
keywords="digital health",
keywords="chronic disease",
keywords="chronic condition",
keywords="health promotion",
keywords="cancer",
keywords="survivor",
keywords="thematic analysis",
keywords="research tool",
keywords="measurement tool",
abstract="Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. ",
doi="10.2196/35933",
url="https://formative.jmir.org/2022/11/e35933",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346647"
}


@Article{info:doi/10.2196/38387,
author="Jarman, K. Hannah
and McLean, A. Si{\^a}n
and Rodgers, Rachel
and Fuller-Tyszkiewicz, Matthew
and Paxton, Susan
and O'Gorman, Beth
and Harris, Emily
and Shatte, Adrian
and Bishop, Katie
and Baumann, Tahlia
and Mahoney, Danielle
and Daugelat, Melissa-Claire
and Yager, Zali",
title="Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="31",
volume="6",
number="10",
pages="e38387",
keywords="eating disorders",
keywords="app-based intervention",
keywords="lived experience",
keywords="design thinking",
keywords="interviews",
keywords="young women",
keywords="co-design",
keywords="mobile health",
keywords="mHealth",
abstract="Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. ",
doi="10.2196/38387",
url="https://formative.jmir.org/2022/10/e38387",
url="http://www.ncbi.nlm.nih.gov/pubmed/36315225"
}


@Article{info:doi/10.2196/38215,
author="Branch, H. OraLee
and Rikhy, Mohit
and Auster-Gussman, A. Lisa
and Lockwood, G. Kimberly
and Graham, A. Sarah",
title="Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App--Based Hypertension Care Program: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="27",
volume="6",
number="10",
pages="e38215",
keywords="high blood pressure",
keywords="obesity",
keywords="weight loss",
keywords="conversational artificial intelligence",
keywords="lifestyle coaching",
abstract="Background: Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. Objective: This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Methods: Participants (N=864) had a baseline systolic BP (SBP) ?120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. Results: By month 3, there was a significant drop of --5.4 mm Hg (95\% CI --6.5 to --4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ?5 mm Hg by month 3 (178/349, 51.0\%) and month 6 (98/199, 49.2\%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of --12.4 mm Hg (SE 1.2 mm Hg) by month 3 and --13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by --5.2 mm Hg (SE 0.8) mm Hg by month 3 and --7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by --1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP ($\beta$=.11; P<.001), percent weight change ($\beta$=--.36; P=.02), and initial BMI ($\beta$=--.56; P<.001) were significantly associated with the likelihood of lowering SBP ?5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was --0.0024 (95\% CI --0.0052 to 0; P=.002). Conclusions: A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ?5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss. ",
doi="10.2196/38215",
url="https://formative.jmir.org/2022/10/e38215",
url="http://www.ncbi.nlm.nih.gov/pubmed/36301618"
}


@Article{info:doi/10.2196/40316,
author="Long, Zhiwen
and Huang, Shan
and Zhang, Jie
and Zhang, Deng
and Yin, Jun
and He, Chengyuan
and Zhang, Qinqiu
and Xu, Huilin
and He, Huimin
and Sun, Ching Ho
and Xie, Ke",
title="A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="26",
volume="6",
number="10",
pages="e40316",
keywords="digital tool",
keywords="nutritional risk screening",
keywords="dietary assessment",
keywords="validity",
keywords="cancer patients",
abstract="Background: Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. Objective: This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. Methods: We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, $\kappa$ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. Results: A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5\%, 81.0\%, and 76.7\% and 69.3\%, 84.5\%, and 64.5\%, respectively), and fair agreement ($\kappa$=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions: The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528 ",
doi="10.2196/40316",
url="https://formative.jmir.org/2022/10/e40316",
url="http://www.ncbi.nlm.nih.gov/pubmed/36287601"
}


@Article{info:doi/10.2196/41418,
author="Bakre, Shivani
and Shea, Benjamin
and Ortega, Kaylee
and Scharen, Jared
and Langheier, Jason
and Hu, Emily",
title="Changes in Food Insecurity Among Individuals Using a Telehealth and Nutrition Platform: Longitudinal Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="25",
volume="6",
number="10",
pages="e41418",
keywords="food insecurity",
keywords="tele-nutrition",
keywords="telehealth",
keywords="meal planning",
keywords="SNAP",
keywords="diet",
keywords="nutrition",
keywords="COVID-19",
abstract="Background: Food insecurity is a complex public health problem affecting many individuals in the United States. Digital health interventions that promote behavior change and provide access to affordable and healthy food may help to alleviate food insecurity. Objective: The aim of this study was to characterize food-insecure users of Foodsmart, a telehealth and nutrition platform with meal planning, food ordering, nutrition education, budgeting, and grocery discount features, and to evaluate changes in diet and food insecurity. Methods: We retrospectively analyzed data collected from 4595 adults who used the Foodsmart platform between February and October 2021. Participants self-reported their diet, demographics, biometrics, and food insecurity status in a 56-item questionnaire. Participants were reported to be food insecure if they answered ``sometimes'' or ``often'' to the question ``How often does the food you buy not last and you don't have money to get more?'' from the United States Department of Agriculture's Household Food Security survey. We examined baseline characteristics of participants by food insecurity status, associations between characteristics and baseline food insecurity, and changes in diet quality and food insecurity status. To evaluate potential causes of reversing food insecurity, the use of 6 Foodsmart features was compared between food-insecure participants who achieved food security versus food-insecure participants who remained food insecure, based on their last response to the food insecurity question. Results: We found that 16\% (742/4595) of participants were food insecure at baseline. Participants who were food insecure at baseline were more likely to be obese, to have at least one chronic condition, to have a lower diet quality, to cook less frequently at home, to think healthy food is too expensive, and less likely to order takeout or eat at a restaurant. Among participants who were food insecure at baseline, 61\% (451/742) improved their nutrition and 29\% (217/742) responded that they were food secure at follow-up, with an increasing percentage achieving food security with longer enrollment time. Using a multivariable logistic regression model, we found that age, diabetes, prediabetes, BMI categories, and diet quality at baseline were statistically significantly associated with the likelihood of being food insecure at baseline. Among those who were food insecure at baseline, there was a higher relative proportion of participants who achieved food security and used the ``deals'' (28.6\% higher), ``CookItNow'' (36.4\% higher), and ``telenutrition'' (27.5\% higher) features compared to those who remained food insecure. Conclusions: This study assesses the characteristics of individuals enrolled on the Foodsmart platform who answered the food insecurity question. We found that a significant number of participants who were food insecure at enrollment achieved food security. This finding shows that telehealth and nutrition platforms may potentially help users improve household food security. ",
doi="10.2196/41418",
url="https://formative.jmir.org/2022/10/e41418",
url="http://www.ncbi.nlm.nih.gov/pubmed/36282563"
}


@Article{info:doi/10.2196/36275,
author="Horne, Maria
and Hardy, Maryann
and Murrells, Trevor
and Ugail, Hassan
and Hill, John Andrew",
title="Using Personalized Avatars as an Adjunct to an Adult Weight Loss Management Program: Randomized Controlled Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="5",
volume="6",
number="10",
pages="e36275",
keywords="avatar",
keywords="feasibility",
keywords="obesity",
keywords="weight loss",
keywords="weight management",
abstract="Background: Obesity is a global public health concern. Interventions rely predominantly on managing dietary intake and increasing physical activity; however, sustained adherence to behavioral regimens is often poor. The lack of sustained motivation, self-efficacy, and poor adherence to behavioral regimens are recognized barriers to successful weight loss. Avatar-based interventions achieve better patient outcomes in the management of chronic conditions by promoting more active engagement. Virtual representations of self can affect real-world behavior, acting as a catalyst for sustained weight loss behavior. Objective: We evaluated whether a personalized avatar, offered as an adjunct to an established weight loss program, can increase participant motivation, sustain engagement, optimize service delivery, and improve participant health outcomes. Methods: A feasibility randomized design was used to determine the case for future development and evaluation of avatar-based technology in a randomized controlled trial. Participants were recruited from general practitioner referrals to a 12-week National Health Service weight improvement program. The main outcome measure was weight loss. Secondary outcome measures were quality-of-life and self-efficacy. Quantitative data were subjected to descriptive statistical tests and exploratory comparison between intervention and control arms. Feasibility and acceptability were assessed through interviews and analyzed using framework approach. Health Research Authority ethics approval was granted. Results: Overall, 10 men (n=7, 70\% for routine care and avatar and n=3, 30\% for routine care) and 33 women (n=23, 70\% for intervention and n=10, 30\% for routine care) were recruited. Participants' initial mean weight was greater in the intervention arm than in the routine care arm (126.3 kg vs 122.9 kg); pattern of weight loss was similar across both arms of the study in T0 to T1 period but accelerated in T1 to T2 period for intervention participants, suggesting that access to the self-resembling avatar may promote greater engagement with weight loss initiatives in the short-to-medium term. Mean change in participants' weight from T0 to T2 was 4.5 kg (95\% CI 2.7-6.3) in the routine care arm and 5.3 kg (95\% CI 3.9-6.8) in the intervention arm. Quality-of-life and self-efficacy measures demonstrated greater improvement in the intervention arm at both T1 (105.5 for routine care arm and 99.7 for intervention arm) and T2 (100.1 for routine care arm and 81.2 for intervention arm). Overall, 13 participants (n=11, 85\% women and n=2, 15\% men) and two health care professionals were interviewed about their experience of using the avatar program. Conclusions: Participants found using the personalized avatar acceptable, and feedback reiterated that seeing a future self helped to reinforce motivation to change behavior. This feasibility study demonstrated that avatar-based technology may successfully promote engagement and motivation in weight loss programs, enabling participants to achieve greater weight loss gains and build self-confidence. Trial Registration: ISRCTN Registry 17953876; https://doi.org/10.1186/ISRCTN17953876 ",
doi="10.2196/36275",
url="https://formative.jmir.org/2022/10/e36275",
url="http://www.ncbi.nlm.nih.gov/pubmed/36197703"
}


@Article{info:doi/10.2196/35896,
author="Torres, Luisa
and Lee, L. Joy
and Park, Seho
and Di Lorenzo, Christian R.
and Branam, P. Jonathan
and Fraser, A. Shelagh
and Salisbury, A. Benjamin",
title="Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: Large-Scale, 52-Week Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Oct",
day="4",
volume="10",
number="10",
pages="e35896",
keywords="intermittent fasting",
keywords="time-restricted eating",
keywords="weight loss",
keywords="obesity",
keywords="mobile apps",
keywords="diet trackers",
keywords="retention",
abstract="Background: Intermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics. Objective: This study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change. Methods: We assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. Results: A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7\%) users were retained at 13 weeks, 54,881 (6.9\%) at 26 weeks, and 16,478 (2.1\%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ?40 kg/m2 lost 13.9\% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1\% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors. Conclusions: IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more. ",
doi="10.2196/35896",
url="https://mhealth.jmir.org/2022/10/e35896",
url="http://www.ncbi.nlm.nih.gov/pubmed/36194463"
}


@Article{info:doi/10.2196/39741,
author="Hesseldal, Laura
and Christensen, Reffstrup Jeanette
and Olesen, Bastholm Thomas
and Olsen, Hecht Michael
and Jakobsen, Ravn Pernille
and Laursen, Hjorth Ditte
and Lauridsen, Trankj{\ae}r J{\o}rgen
and Nielsen, Bo Jesper
and S{\o}ndergaard, Jens
and Brandt, Joakim Carl",
title="Long-term Weight Loss in a Primary Care--Anchored eHealth Lifestyle Coaching Program: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="23",
volume="24",
number="9",
pages="e39741",
keywords="obesity",
keywords="digital behavioral coaching",
keywords="health behavior change",
keywords="interactive advice",
keywords="lifestyle change",
keywords="mobile intervention",
keywords="patient engagement",
keywords="telemedicine",
keywords="eHealth",
keywords="digital health",
keywords="digital coach",
keywords="weight loss",
keywords="coaching",
keywords="training",
keywords="engagement",
keywords="behavior changes",
keywords="diabetes",
keywords="type 2 diabetes",
keywords="T2D",
abstract="Background: Long-term weight loss in people living with obesity can reduce the risk and progression of noncommunicable diseases. Observational studies suggest that digital coaching can lead to long-term weight loss. Objective: We investigated whether an eHealth lifestyle coaching program for people living with obesity with or without type 2 diabetes led to significant, long-term (12-month) weight loss compared to usual care. Methods: In a randomized controlled trial that took place in 50 municipalities in Denmark, 340 people living with obesity with or without type 2 diabetes were enrolled from April 16, 2018, to April 1, 2019, and randomized via an automated computer algorithm to an intervention (n=200) or a control (n=140) group. Patients were recruited via their general practitioners, the Danish diabetes organization, and social media. The digital coaching intervention consisted of an initial 1-hour face-to-face motivational interview followed by digital coaching using behavioral change techniques enabled by individual live monitoring. The primary outcome was change in body weight from baseline to 12 months. Results: Data were assessed for 200 participants, including 127 from the intervention group and 73 from the control group, who completed 12 months of follow-up. After 12 months, mean body weight and BMI were significantly reduced in both groups but significantly more so in the intervention group than the control group (--4.5 kg, 95\% CI --5.6 to --3.4 vs --1.5 kg, 95\% CI --2.7 to --0.2, respectively; P<.001; and --1.5 kg/m2, 95\% CI --1.9 to --1.2 vs --0.5 kg/m2, 95\% CI --0.9 to --0.1, respectively; P<.001). Hemoglobin A1c was significantly reduced in both the intervention (--6.0 mmol/mol, 95\% CI --7.7 to --4.3) and control (--4.9 mmol/mol, 95\% CI --7.4 to --2.4) groups, without a significant group difference (all P>.46). Conclusions: Compared to usual care, digital lifestyle coaching can induce significant weight loss for people living with obesity, both with and without type 2 diabetes, after 12 months. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 ",
doi="10.2196/39741",
url="https://www.jmir.org/2022/9/e39741",
url="http://www.ncbi.nlm.nih.gov/pubmed/36149735"
}


@Article{info:doi/10.2196/40141,
author="Chew, Jocelyn Han Shi
and Koh, Ling Wee
and Ng, Yi Janelle Shaina Hui
and Tan, Kan Ker",
title="Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="21",
volume="24",
number="9",
pages="e40141",
keywords="smartphone app",
keywords="mobile app",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="weight management",
keywords="weight loss",
keywords="obesity",
keywords="app",
keywords="diet",
keywords="eating",
keywords="mobile phone",
abstract="Background: Evidence on the long-term effects of weight management smartphone apps on various weight-related outcomes remains scarce. Objective: In this review, we aimed to examine the effects of smartphone apps on anthropometric, metabolic, and dietary outcomes at various time points. Methods: Articles published from database inception to March 10, 2022 were searched, from 7 databases (Embase, CINAHL, PubMed, PsycINFO, Cochrane Library, Scopus, and Web of Science) using forward and backward citation tracking. All randomized controlled trials that reported weight change as an outcome in adults with overweight and obesity were included. We performed separate meta-analyses using random effects models for weight, waist circumference, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood glucose level, blood pressure, and total energy intake per day. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Based on our meta-analyses, weight loss was sustained between 3 and 12 months, with a peak of 2.18 kg at 3 months that tapered down to 1.63 kg at 12 months. We did not find significant benefits of weight loss on the secondary outcomes examined, except for a slight improvement in systolic blood pressure at 3 months. Most of the included studies covered app-based interventions that comprised of components beyond food logging, such as real-time diet and exercise self-monitoring, personalized and remote progress tracking, timely feedback provision, smart devices that synchronized activity and weight data to smartphones, and libraries of diet and physical activity ideas. Conclusions: Smartphone weight loss apps are effective in initiating and sustaining weight loss between 3 and 12 months, but their effects are minimal in their current states. Future studies could consider the various aspects of the socioecological model. Conversational and dialectic components that simulate health coaches could be useful to enhance user engagement and outcome effectiveness. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329197; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=329197 ",
doi="10.2196/40141",
url="https://www.jmir.org/2022/9/e40141",
url="http://www.ncbi.nlm.nih.gov/pubmed/36129739"
}


@Article{info:doi/10.2196/37637,
author="Garcia, O. David
and Valdez, A. Luis
and Aceves, Benjamin
and Bell, L. Melanie
and Rabe, A. Brooke
and Villavicencio, A. Edgar
and Marrero, G. David
and Melton, Forest
and Hooker, P. Steven",
title="mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="21",
volume="6",
number="9",
pages="e37637",
keywords="Hispanic",
keywords="mobile health",
keywords="mHealth",
keywords="overweight",
keywords="obesity",
keywords="weight loss",
abstract="Background: Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. Objective: This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. Methods: A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m{\texttwosuperior}; 10/18, 56\% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ?225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants' weight loss experiences and perspectives on mHealth technologies. Results: Of 18 participants, 16 (89\%) completed the 12-week assessments; the overall attrition rate was 11.1\%. The mean weight loss at week 12 was ?4.7 kg (95\% CI 7.1 to ?2.4 kg; P<.001). Participants wore the Fitbit 71.58\% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51\% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. Conclusions: Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. Trial Registration: ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521 ",
doi="10.2196/37637",
url="https://formative.jmir.org/2022/9/e37637",
url="http://www.ncbi.nlm.nih.gov/pubmed/36129735"
}


@Article{info:doi/10.2196/38262,
author="Miller, N. Hailey
and Voils, I. Corrine
and Cronin, A. Kate
and Jeanes, Elizabeth
and Hawley, Jeffrey
and Porter, S. Laura
and Adler, R. Rachel
and Sharp, Whitney
and Pabich, Samantha
and Gavin, L. Kara
and Lewis, A. Megan
and Johnson, M. Heather
and Yancy Jr, S. William
and Gray, E. Kristen
and Shaw, J. Ryan",
title="A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="6",
volume="6",
number="9",
pages="e38262",
keywords="text message",
keywords="weight management",
keywords="automation",
keywords="clinical trial",
keywords="engagement",
keywords="digital technology",
keywords="electronic data capture",
keywords="REDCap",
keywords="automated text message",
keywords="digital health intervention",
keywords="health intervention",
keywords="health database",
keywords="digital health",
abstract="Background: The use of digital technologies and software allows for new opportunities to communicate and engage with research participants over time. When software is coupled with automation, we can engage with research participants in a reliable and affordable manner. Research Electronic Data Capture (REDCap), a browser-based software, has the capability to send automated text messages. This feature can be used to automate delivery of tailored intervention content to research participants in interventions, offering the potential to reduce costs and improve accessibility and scalability. Objective: This study aimed to describe the development and use of 2 REDCap databases to deliver automated intervention content and communication to index participants and their partners (dyads) in a 2-arm, 24-month weight management trial, Partner2Lose. Methods: Partner2Lose randomized individuals with overweight or obesity and cohabitating with a partner to a weight management intervention alone or with their partner. Two databases were developed to correspond to 2 study phases: one for weight loss initiation and one for weight loss maintenance and reminders. The weight loss initiation database was programmed to send participants (in both arms) and their partners (partner-assisted arm) tailored text messages during months 1-6 of the intervention to reinforce class content and support goal achievement. The weight maintenance and reminder database was programmed to send maintenance-related text messages to each participant (both arms) and their partners (partner-assisted arm) during months 7-18. It was also programmed to send text messages to all participants and partners over the course of the 24-month trial to remind them of group classes, dietary recall and physical activity tracking for assessments, and measurement visits. All text messages were delivered via Twilio and were unidirectional. Results: Five cohorts, comprising 231 couples, were consented and randomized in the Partner2Lose trial. The databases will send 53,518 automated, tailored text messages during the trial, significantly reducing the need for staff to send and manage intervention content over 24 months. The cost of text messaging will be approximately US \$450. Thus far, there is a 0.004\% known error rate in text message delivery. Conclusions: Our trial automated the delivery of tailored intervention content and communication using REDCap. The approach described provides a framework that can be used in future behavioral health interventions to create an accessible, reliable, and affordable method for intervention delivery and engagement that requires minimal trial-specific resources and personnel time. Trial Registration: ClinicalTrials.gov NCT03801174; https://clinicaltrials.gov/ct2/show/NCT03801174?term=NCT03801174 ",
doi="10.2196/38262",
url="https://formative.jmir.org/2022/9/e38262",
url="http://www.ncbi.nlm.nih.gov/pubmed/36066936"
}


@Article{info:doi/10.2196/38520,
author="Mathisen, Fostervold Therese
and Johansen, Ramstad Frode",
title="The Impact of Smartphone Apps Designed to Reduce Food Waste on Improving Healthy Eating, Financial Expenses and Personal Food Waste: Crossover Pilot Intervention Trial Studying Students' User Experiences",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="2",
volume="6",
number="9",
pages="e38520",
keywords="smartphone app",
keywords="food waste",
keywords="healthy eating",
keywords="diet",
keywords="automatic",
keywords="registration",
keywords="global sustainability",
keywords="financial expenses",
abstract="Background: Global sustainability and individual health need coordinated attention. While individuals are recommended a healthy diet to reduce the burden of noncommunicable diseases, global attention to natural resource conservation is also needed. The latter specifically means effective measures to reduce food waste. Objective: This pilot study evaluates the experiences of students and effect from using smartphone apps designed to reduce food waste on personal healthy eating, financial expenses, and food waste. Methods: A total of 6 students from different study programs (mean age 24.7, SD 2.9) were recruited to evaluate 2 different apps designed to reduce food waste and to register food consumption, food waste, and financial food expenses before and after the app trials. The apps evaluated were the commercially available TotalCtrl Home and Too-Good-To-Go. Results were analyzed by mixed methods, comprising statistical analyses for quantifiable data and thematic analyses for qualitative data. The apps were used separately in random order, each for 1 month. Primary outcome was user expectations to and experiences from the use of the apps, which were obtained by semistructured interviews. Secondary outcomes were changes in food waste volume, financial food expenses, and healthy eating. While information on food waste and food expenses was obtained by weighing food waste and registering food costs for 2 weeks before and after app trials, scores for consuming healthy diets were calculated from registered food records by scoring criteria matched to national recommendations for healthy eating. Results: Awareness on food waste increased after app trials, but experiences with apps pointed toward several potential for technical and content improvements. The students reported that there were too many manual operations in the apps to induce permanent use (TotalCtrl Home), that services seemed more concerned about the producers' interests than the individual's needs (Too-Good-To-Go), and that they missed a composite app that included functions to promote healthy eating and overview of budget and expenses as well as of food waste (both apps). Use of apps designed to reduce food waste and personal costs and to improve healthy eating did not result in any measurable effects, that is, no change in food waste (mean change 0.81, SD 1.5 kg; P=.13), healthy eating (mean change --0.24, SD 0.43; P=.24), or personal food expenses (mean change 47.5 NOK or US \$4.8, SD 416.9 NOK or US \$42.5; P=.39). Conclusions: Apps may aid in increased awareness of food waste at the producer and consumer levels. Large-scale studies with longer duration are needed to see if apps may induce measurable changes in food waste, healthy eating, and financial expenses. ",
doi="10.2196/38520",
url="https://formative.jmir.org/2022/9/e38520",
url="http://www.ncbi.nlm.nih.gov/pubmed/36053667"
}


@Article{info:doi/10.2196/37634,
author="Strid, Nilsing Emma
and Wallin, Lars
and Nilsag{\aa}rd, Ylva",
title="Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the ``Act in Time'' Mixed Methods Process Evaluation Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="19",
volume="11",
number="8",
pages="e37634",
keywords="implementation science",
keywords="facilitation",
keywords="practice guideline",
keywords="lifestyle",
keywords="health promotion",
keywords="primary health care",
keywords="health personnel",
keywords="qualitative research",
keywords="quality improvement",
abstract="Background: There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC). Objective: This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs. Methods: A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source. Results: Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023. Conclusions: This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators. Trial Registration: ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860 International Registered Report Identifier (IRRID): DERR1-10.2196/37634 ",
doi="10.2196/37634",
url="https://www.researchprotocols.org/2022/8/e37634",
url="http://www.ncbi.nlm.nih.gov/pubmed/35984700"
}


@Article{info:doi/10.2196/40191,
author="Fleary, A. Sasha",
title="A Web-Based Intervention to Improve Health Literacy and Obesogenic Behaviors Among Adolescents: Protocol of a Randomized Pilot Feasibility Study for a Parallel Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="16",
volume="11",
number="8",
pages="e40191",
keywords="health literacy",
keywords="adolescent",
keywords="obesity",
keywords="prevention",
keywords="diet",
keywords="physical activity",
keywords="web-based intervention",
keywords="eHealth",
abstract="Background: Predictive theoretical models suggest that health knowledge works in conjunction with motivation and behavioral skills to influence adolescents' obesogenic behavior. However, most of the existing adolescent interventions target these variables in isolation. Furthermore, health literacy (HL), a precursor to health knowledge, is necessary for translating health knowledge into behavior and is negatively related to adolescents' obesity status. However, HL has not been included in obesity interventions targeting adolescents. Objective: This study aims to pilot the feasibility of a 2-armed web-based obesity prevention intervention in school settings and assess the preliminary effectiveness of adding an HL module to an obesity prevention intervention for adolescents. Methods: This web-based pilot feasibility study will take place in the Northeastern United States. Participants will be adolescents (aged 13-16 years) attending school, and recruitment will be conducted through flyers to parents and adolescents in participating classes or advisory groups at the school. The intervention includes 2 arms: an experimental arm that will receive an HL module and 3 obesity prevention modules and a comparison arm that will receive a vaping module and 3 obesity prevention modules. A blinded randomized procedure will be used to allocate classrooms and advisory groups to the experimental and comparison arms. The intervention will be fully web-based. Participants will complete measures of their HL and obesogenic behavior--related health knowledge, motivation, and behaviors at 3 time points (baseline, 1 month after the intervention, and 3 months after the intervention) via web-based surveys. The primary outcomes will be the measures of study feasibility (recruitment, retention, completion, and treatment fidelity rates). Secondary outcomes will be preliminary efficacy, as measured by logistic and linear regressions and calculation of effect sizes. Descriptive statistics will be calculated for all measures at each time point. Results: This study was approved by the City University of New York Institutional Review Board in August 2020. As of June 2022, the web-based intervention design is complete and ready for use. Recruitment, data collection, and intervention implementation are scheduled to begin in September 2022. These results are expected to be published in 2023. Conclusions: This study's feasibility findings will inform changes to the intervention content and randomized controlled trial design. The study's efficacy findings will inform the sample size for the full-scale randomized controlled trial and the preliminary utility of the intervention. Trial Registration: ClinicalTrials.gov NCT04252677; https://clinicaltrials.gov/ct2/show/NCT04252677 International Registered Report Identifier (IRRID): PRR1-10.2196/40191 ",
doi="10.2196/40191",
url="https://www.researchprotocols.org/2022/8/e40191",
url="http://www.ncbi.nlm.nih.gov/pubmed/35972787"
}


@Article{info:doi/10.2196/37541,
author="Sysko, Robyn
and Bibeau, Jessica
and Boyar, Allison
and Costello, Kayla
and Michaelides, Andreas
and Mitchell, Siobhan Ellen
and Susanin, Annabel
and Hildebrandt, Tom",
title="A 2.5-Year Weight Management Program Using Noom Health: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="12",
volume="11",
number="8",
pages="e37541",
keywords="weight loss",
keywords="weight loss maintenance",
keywords="digital health",
keywords="Noom",
keywords="Diabetes Prevention Program",
keywords="DPP",
keywords="mobile phone",
abstract="Background: Overweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs. Objective: This weight loss trial will aim to examine the efficacy of the Noom weight loss program in comparison to a digital control after a 6-month intervention phase and a 24-month maintenance phase, with assessments continuing for 2 years beyond the intervention (to 30 months---after the baseline). The secondary outcomes include quality of life, psychosocial functioning, sleep quality, physical activity, diet, and health status. This trial will also examine the severity of obesity-related functional impairment, weight loss history, and demographic moderators, along with adherence and self-efficacy as mediators of the outcome. Methods: A total of 600 participants were randomized in a parallel-group, controlled trial to either Noom Healthy Weight Program (intervention) or Noom Healthy Weight Control (control) for a 6-month intervention. Both intervention and control groups include diet and exercise recommendations, educational content, daily logging capabilities, and daily weigh-in entries. The Noom Healthy Weight Program also includes a coach support for weight loss. Remote follow-up assessments of eating, physical activity, psychosocial factors, app use data, and weight will be conducted at 1, 4, 6, 12, 18, 24, and 30 months after baseline. Weight is measured at each follow-up point during a Zoom call using the participants' scales. Results: Enrollment began in March 2021 and the 6-month intervention phase ended in March 2022. Data collection for the final assessment will be completed in March 2024. Conclusions: This study tests commercially available digital lifestyle interventions for individuals with overweight and obesity seeking weight loss support. Data obtained from the study will evaluate whether the Noom Healthy Weight Control Program can help individuals overcome weight loss, achieve long-term maintenance, adhere to lifestyle changes, and feature use barriers that are present in other traditional weight loss treatments. Trial Registration: ClinicalTrials.gov NCT04797169; https://clinicaltrials.gov/ct2/show/NCT04797169 International Registered Report Identifier (IRRID): DERR1-10.2196/37541 ",
doi="10.2196/37541",
url="https://www.researchprotocols.org/2022/8/e37541",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969439"
}


@Article{info:doi/10.2196/40568,
author="Waselewski, Marika
and Plegue, Melissa
and Sonneville, Kendrin
and Resnicow, Ken
and Ghumman, Aisha
and Ebbeling, Cara
and Mahmoudi, Elham
and Sen, Ananda
and Wolfson, A. Julia
and Chang, Tammy",
title="Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="5",
volume="11",
number="8",
pages="e40568",
keywords="pregnancy",
keywords="weight",
keywords="diet",
keywords="grocery delivery",
abstract="Background: Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease. Objective: This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants. Methods: A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment. Results: This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026. Conclusions: This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health. Trial Registration: ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645 International Registered Report Identifier (IRRID): DERR1-10.2196/40568 ",
doi="10.2196/40568",
url="https://www.researchprotocols.org/2022/8/e40568",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930351"
}


@Article{info:doi/10.2196/35197,
author="C Braga, Bianca
and Nguyen, H. Phuong
and Aberman, Noora-Lisa
and Doyle, Frank
and Folson, Gloria
and Hoang, Nga
and Huynh, Phuong
and Koch, Bastien
and McCloskey, Peter
and Tran, Lan
and Hughes, David
and Gelli, Aulo",
title="Exploring an Artificial Intelligence--Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="21",
volume="6",
number="7",
pages="e35197",
keywords="adolescent",
keywords="dietary quality",
keywords="food choice",
keywords="gamification",
keywords="low- and middle-income country",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: Adolescents' consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents' fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence--based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app. Methods: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users' medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app's feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent's feedback to improve its acceptability, usability, and likability. Conclusions: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale. ",
doi="10.2196/35197",
url="https://formative.jmir.org/2022/7/e35197",
url="http://www.ncbi.nlm.nih.gov/pubmed/35862147"
}


@Article{info:doi/10.2196/35553,
author="Kempler, V. Jessica
and Love, Penelope
and Bolton, A. Kristy
and Rozman, Margaret
and Spence, C. Alison",
title="Exploring the Use of a Web-Based Menu Planning Tool in Childcare Services: Qualitative Cross-sectional Survey Study",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="18",
volume="6",
number="7",
pages="e35553",
keywords="child care",
keywords="preschool",
keywords="early childhood services",
keywords="child nutrition",
keywords="menu planning",
keywords="healthy eating",
keywords="web-based systems",
keywords="web-based tool",
keywords="internet-based intervention",
keywords="user experience",
abstract="Background: Early childhood is a critical period for supporting the development of healthy eating habits, which may affect lifelong health. Childcare services are important settings for promoting early childhood nutrition; however, food provision in childcare frequently does not align with dietary guidelines. Web-based menu planning tools are well suited to support healthy food provision in childcare, although little is known about their use. Research is needed to understand how web-based menu planning tools are used in the childcare setting and how they can effectively support healthy menu planning and food provision for children in childcare. Objective: We aimed to explore the use of a web-based menu planning tool called FoodChecker, which is available to childcare services in Victoria, Australia. We also aimed to gain insights and perspectives from childcare staff involved in menu planning about their use of the tool to plan healthy menus and guide healthy food provision for children. Methods: We conducted a qualitative descriptive study using a cross-sectional web-based survey completed by the staff involved in menu planning in childcare services. Thematic analysis was performed using NVivo software. Emergent themes were mapped against constructs of the Technology Acceptance Model regarding perceived usefulness, perceived ease of use, and external variables influencing perceptions and use. Results: The participants included 30 cooks and 34 directors from 53 childcare services. Participants perceived the web-based menu planning tool as useful for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role. Perceptions regarding ease of use were mixed. External variables influencing perceptions and use included awareness of the tool, perceived need, time, resources, organizational support, and the food budget. Participants made recommendations to improve the tool, particularly the need to integrate functionality to make it easier and faster to use or to include more links to resources to support healthy menu planning. Conclusions: The web-based menu planning tool was perceived as useful for cooks and directors in childcare services. Areas for improvement were identified; for example, the need for integrated digital features to make the tool easier and faster to use. As the first qualitative study to explore childcare staff experiences with a web-based menu planning tool, these findings inform future research and development of such tools to aid scalable and sustainable support for healthier food provision in the childcare sector. ",
doi="10.2196/35553",
url="https://formative.jmir.org/2022/7/e35553",
url="http://www.ncbi.nlm.nih.gov/pubmed/35849438"
}


@Article{info:doi/10.2196/36811,
author="Lim, Xiang Wei
and Fook-Chong, Stephanie
and Lim, Wah John
and Gan, Hoe Wee",
title="The Outcomes of App-Based Health Coaching to Improve Dietary Behavior Among Nurses in a Tertiary Hospital: Pilot Intervention Study",
journal="JMIR Nursing",
year="2022",
month="Jul",
day="15",
volume="5",
number="1",
pages="e36811",
keywords="smartphone app",
keywords="weight loss",
keywords="dietary behavior",
keywords="nurse",
keywords="app",
keywords="mobile health",
keywords="mHealth",
keywords="app-based health",
keywords="health coaching",
keywords="diet",
keywords="dietary choice",
abstract="Background: At the workplace, health care workers face multiple challenges in maintaining healthy dietary behaviors, which is the major factor behind obesity. A hospital-wide mass health screening exercise showed an increasing trend in the prevalence of obesity and median BMI from 2004 to 2019, as well as a higher crude obesity rate among shift workers. Objective: We aimed to evaluate the effectiveness of mobile app--based health coaching and incentives for achieving weight loss from better dietary choices among hospital nurses. Methods: We conducted a pilot study from June 2019 to March 2020, involving the use of a health-coaching app by 145 hospital nurses over 6 months. Weight and BMI were self-reported, and food scores were calculated. Data among overweight nurses, shift work nurses, and incentive groups were analyzed. Results: A total of 61 nurses were included in the final analysis. Of these 61 nurses, 38 (62\%) lost weight. The median percentage weight loss was 1.2\% (IQR 0\%-2.9\%; P<.001), and the median decrease in BMI was 0.35 (IQR ?0.15 to 0.82; P<.001), but they were not clinically significant. The median improvement in the food score was 0.4 (IQR 0-0.8). There was no difference between the incentive and nonincentive groups. A total of 49 (34\%) participants engaged for ?8 weeks. Conclusions: The study demonstrated an association between the use of app-based health coaching and the attainment of some weight loss in nurses, without a significant improvement in the food score. Incentives may nudge on-boarding, but do not sustain engagement. ",
doi="10.2196/36811",
url="https://nursing.jmir.org/2022/1/e36811",
url="http://www.ncbi.nlm.nih.gov/pubmed/35838811"
}


@Article{info:doi/10.2196/38243,
author="Burke, E. Lora
and Sereika, M. Susan
and Bizhanova, Zhadyra
and Parmanto, Bambang
and Kariuki, Jacob
and Cheng, Jessica
and Beatrice, Britney
and Cedillo, Maribel
and Pulantara, Wayan I.
and Wang, Yuhan
and Loar, India
and Conroy, B. Molly",
title="The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="5",
volume="24",
number="7",
pages="e38243",
keywords="self-monitoring",
keywords="behavioral intervention/weight loss",
keywords="feedback messages",
keywords="engagement",
keywords="mHealth",
keywords="adherence",
keywords="obesity",
keywords="randomized clinical trial",
keywords="smart scales",
keywords="physical activity trackers",
keywords="digital health",
abstract="Background: Self-monitoring (SM) is the centerpiece of behavioral weight loss treatment, but the efficacy of smartphone-delivered SM feedback (FB) has not been tested in large, long-term, randomized trials. Objective: The aim of this study was to establish the efficacy of providing remote FB to diet, physical activity (PA), and weight SM on improving weight loss outcomes when comparing the SM plus FB (SM+FB) condition to the SM-only condition in a 12-month randomized controlled trial. The study was a single-site, population-based trial that took place in southwestern Pennsylvania, USA, conducted between 2018 and 2021. Participants were smartphone users age ?18 years, able to engage in moderate PA, with a mean BMI between 27 and 43 kg/m2. Methods: All participants received a 90-minute, one-to-one, in-person behavioral weight loss counseling session addressing behavioral strategies, establishing participants' dietary and PA goals, and instructing on use of the PA tracker (Fitbit Charge 2), smart scale, and diet SM app. Only SM+FB participants had access to an investigator-developed smartphone app that read SM data, in which an algorithm selected tailored messages sent to the smartphone up to 3 times daily. The SM-only participants did not receive any tailored FB based on SM data. The primary outcome was percent weight change from baseline to 12 months. Secondary outcomes included engagement with digital tools (eg, monthly percentage of FB messages opened and monthly percentage of days adherent to the calorie goal). Results: Participants (N=502) were on average 45.0 (SD 14.4) years old with a mean BMI of 33.7 (SD 4.0) kg/m2. The sample was 79.5\% female (n=399/502) and 82.5\% White (n=414/502). At 12 months, retention was 78.5\% (n=394/502) and similar by group (SM+FB: 202/251, 80.5\%; SM: 192/251, 76.5\%; P=.28). There was significant percent weight loss from baseline in both groups (SM+FB: --2.12\%, 95\% CI --3.04\% to --1.21\%, P<.001; SM: --2.39\%, 95\% CI --3.32\% to --1.47\%; P<.001), but no difference between the groups (--0.27\%; 95\% CI --1.57\% to 1.03\%; t =--0.41; P=.68). Similarly, 26.3\% (66/251) of the SM+FB group and 29.1\% (73/251) of the SM group achieved ?5\% weight loss (chi-square value=0.49; P=.49). A 1\% increase in FB messages opened was associated with a 0.10 greater percent weight loss at 12 months (b=--0.10; 95\% CI --0.13 to --0.07; t =--5.90; P<.001). A 1\% increase in FB messages opened was associated with 0.12 greater percentage of days adherent to the calorie goal per month (b=0.12; 95\% CI 0.07-0.17; F=22.19; P<.001). Conclusions: There were no significant between-group differences in weight loss; however, the findings suggested that the use of commercially available digital SM tools with or without FB resulted in a clinically significant weight loss in over 25\% of participants. Future studies need to test additional strategies that will promote greater engagement with digital tools. Trial Registration: Clinicaltrials.gov NCT03367936; https://clinicaltrials.gov/ct2/show/NCT03367936 ",
doi="10.2196/38243",
url="https://www.jmir.org/2022/7/e38243",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787516"
}


@Article{info:doi/10.2196/36770,
author="Liu, Sam
and Smith, Nicholas
and Nuss, Kayla
and Perdew, Megan
and Adiputranto, Dimas
and Naylor, Patti-Jean",
title="Dose-Response Relationship of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: Secondary Analysis of a Behavior Intervention",
journal="JMIR Pediatr Parent",
year="2022",
month="Jul",
day="5",
volume="5",
number="3",
pages="e36770",
keywords="engagement",
keywords="dose response",
keywords="childhood obesity",
keywords="web-based intervention",
keywords="child",
keywords="obesity",
keywords="weight",
keywords="web based",
keywords="intervention",
keywords="family",
keywords="families",
keywords="lifestyle",
keywords="parent",
keywords="parental support",
keywords="healthy eating",
keywords="family support",
keywords="physical activity",
keywords="diet",
keywords="exercise",
keywords="fitness",
keywords="online portal",
abstract="Background: The Early Intervention Program (EIP) was a 10-week, blended, in-person and online lifestyle intervention for families with children who were off the healthy weight trajectory. The engagement pattern and the dose response of EIP have not been examined. Objective: The aims of this paper are to examine families' engagement patterns with the EIP and to evaluate the dose-response relationship between EIP engagement patterns and physical activity and healthy eating--related outcomes at 10 weeks. Methods: Families with children (8-12 years old) who are off the healthy weight trajectory (child BMI ?85th percentile for age and sex) were recruited. Pre- and postintervention questionnaires assessed child lifestyle behaviors, parental support behaviors, family lifestyle habits, as well as parental physical activity and healthy-eating identity. Hierarchical cluster analysis of both in-person and online components was used to classify engagement patterns. Regression analysis assessed differences in outcomes by engagement groups. Results: Two distinct clusters of engagement groups were identified (N=66), which were in-person (IP; n=40, 61\%) and in-person + online (IP+; n=26, 39\%) engagement. Relative to the IP group at week 10, IP+ showed a greater child moderate-to-vigorous physical activity level (1.53, SD 0.56; P=.008), child physical activity confidence (1.04, SD 0.37; P=.007), parental support for child physical activity (5.54, SD 2.57; P=.04) and healthy eating (2.43, SD 1.16; P=.04), family habits for physical activity (3.02, SD 1.50; P=.049) and healthy eating (3.95, SD 1.84; P=.04), and parental identity for physical activity (2.82, SD 1.19; P=.02). Conclusions: The online EIP portal complemented the in-person sessions. Additional engagement with the portal was associated with greater improvements in child physical activity and parental support behaviors, habits, and identity for physical activity. ",
doi="10.2196/36770",
url="https://pediatrics.jmir.org/2022/3/e36770",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787514"
}


@Article{info:doi/10.2196/33137,
author="Chang, Ing-Chau
and Yang, Cheng-Ying
and Yen, Chin-En",
title="The Effects of a Computer Game (Healthy Rat King) on Preschool Children's Nutritional Knowledge and Junk Food Intake Behavior: Nonrandomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="Jul",
day="1",
volume="10",
number="3",
pages="e33137",
keywords="computer games",
keywords="nutrition knowledge",
keywords="junk food",
abstract="Background: Playing computer-aided games could enhance children's interest in learning about nutritional knowledge and eventually promote healthy dietary intake behavior. Objective: This study aims to evaluate the effectiveness of a computer game (Healthy Rat King) in improving the knowledge on nutrition and junk food intake among preschool children in Taiwan. Methods: This was a quasi-experimental study that utilized the computer game Healthy Rat King as the nutrition education tool. We recruited 104 preschool children (aged 5-6 years) from preschools in central Taiwan, who were assigned to either the experimental group (n=56) or the control group (n=48). In the experimental group, a 1-hour computer-based educational game intervention was included in the course for 4 consecutive weeks. The control group did not receive this intervention. Results: The level of nutritional knowledge for children in the experimental group was significantly higher than those in the control group after 4 weeks (P=.002). Furthermore, the frequency of consumption of chocolate, candies, and ice cream (high-calorie junk food) was reduced in the experimental group. There was also no significant difference in the consumption of candy and chocolate (P=.54), ice cream and ice pops (P=.21), cake (P=.92), biscuit (P=.98), soft drinks (P=.52), and fruit juice and sugary drinks (P=.31) between the 2 groups in the posttest. Conclusions: Teaching using a computer game could improve children's nutritional knowledge. However, the intake frequency of junk food among children in the experimental group showed no significant difference from those in the control group. ",
doi="10.2196/33137",
url="https://games.jmir.org/2022/3/e33137",
url="http://www.ncbi.nlm.nih.gov/pubmed/35776502"
}


@Article{info:doi/10.2196/33813,
author="Stoeten, Claudia
and de Haan, Arnoud Hein
and Postel, Gerda Marloes
and Brusse-Keizer, Marjolein
and ter Huurne, Dani{\"e}lle Elke",
title="Therapeutic Alliance in Web-Based Treatment for Eating Disorders: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="30",
volume="6",
number="6",
pages="e33813",
keywords="therapeutic alliance",
keywords="TA",
keywords="treatment completion",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="web-CBT",
keywords="eating disorders",
abstract="Background: In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists. Objective: This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion. Methods: A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion. Results: For treatment completers (128/170, 75.3\%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7\%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. Conclusions: Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients' confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion. ",
doi="10.2196/33813",
url="https://formative.jmir.org/2022/6/e33813",
url="http://www.ncbi.nlm.nih.gov/pubmed/35771608"
}


@Article{info:doi/10.2196/37853,
author="Perin, Sia Milena
and S{\~a}o-Jo{\~a}o, Thais
and Gallani, Jayme Maria Cec{\'i}lia Bueno
and Agbadje, Tatiana Titilayo
and Rodrigues, Matheus Roberta Cunha
and Corn{\'e}lio, Estevam Marilia",
title="A Mobile Phone App Intervention to Promote Healthy Salt Intake Among Adults: Protocol for a Randomized Controlled Study",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="29",
volume="11",
number="6",
pages="e37853",
keywords="mHealth",
keywords="intervention",
keywords="sodium chloride",
keywords="dietary",
keywords="behavior change",
keywords="mobile health",
abstract="Background: There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population's context. Objective: This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. Methods: This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. Results: Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. Conclusions: Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. Trial Registration: The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq International Registered Report Identifier (IRRID): DERR1-10.2196/37853 ",
doi="10.2196/37853",
url="https://www.researchprotocols.org/2022/6/e37853",
url="http://www.ncbi.nlm.nih.gov/pubmed/35767347"
}


@Article{info:doi/10.2196/39669,
author="Horgan, Z. Olivia
and Crane, T. Nicole
and Forman, M. Evan
and Milliron, Brandy-Joe
and Simone, L. Nicole
and Zhang, Fengqing
and Butryn, L. Meghan",
title="Optimizing an mHealth Intervention to Change Food Purchasing Behaviors for Cancer Prevention: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="24",
volume="11",
number="6",
pages="e39669",
keywords="mHealth",
keywords="cancer prevention",
keywords="grocery shopping",
keywords="diet",
keywords="eating",
keywords="mobile phone",
abstract="Background: Dietary intake is a powerful modifiable factor that influences cancer risk; however, most US adults do not adhere to dietary guidelines for cancer prevention. One promising pathway for improving dietary adherence is targeting grocery shopping habits. Interventions might facilitate healthy grocery choices, with a combination of mHealth and traditional methods, by promoting the salience of dietary goals while shopping, enhancing motivation to make dietary changes, and increasing household support for healthy food purchasing. Objective: This pilot study will assess feasibility and acceptability of intervention components designed to improve adherence to dietary guidelines for cancer prevention (preliminary aim). The primary aim of the study is to quantify the effect of each intervention component, individually and in combination, on dietary intake (primary aim) and grocery store food purchases (exploratory aim). Mediation analyses will be conducted to understand the mechanisms of action (goal salience, motivation, and household support---secondary aims). The overarching goal is to optimize an mHealth intervention to be tested in a future fully powered clinical trial. Methods: The study enrolled adults (N=62) with low adherence to dietary recommendations for cancer prevention. In a 20-week program, all participants attend a nutrition education workshop and receive weekly educational messages through an app. A factorial design is used to test 4 intervention components: (1) location-triggered messages: educational messages are delivered when arriving at grocery stores; (2) reflections on the benefits of change: content is added to messages to encourage reflection on anticipated benefits of healthy eating, and participants attend an additional workshop session and 3 coach calls on this topic; (3) coach monitoring: food purchases are monitored digitally by a coach who sends personalized weekly app messages and conducts 3 coaching calls that focus on feedback about purchases; and (4) household support: another adult in the household receives messages designed to elicit support for healthy food purchasing, and support is addressed in 3 coach calls and an extra workshop session attended by the index participant and household member. Assessments are completed at weeks 0, 10, and 20 using self-report measures, as well as objective capture of grocery data from the point of purchase using store loyalty accounts. Results: The National Cancer Institute funded this study (R21CA252933) on July 7, 2020. Participant recruitment began in the spring of 2021 and concluded with the successful enrollment of 62 participants. Data collection is expected to be completed in the summer of 2022, and results are expected to be disseminated in the summer of 2023. Conclusions: The results of this study will inform the development of scalable interventions to lower cancer risk via changes in dietary intake. Trial Registration: ClinicalTrials.gov NCT04947150; https://clinicaltrials.gov/ct2/show/NCT04947150 International Registered Report Identifier (IRRID): DERR1-10.2196/39669 ",
doi="10.2196/39669",
url="https://www.researchprotocols.org/2022/6/e39669",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749216"
}


@Article{info:doi/10.2196/37414,
author="Chwyl, Christina
and Wright, Nicholas
and M Turner-McGrievy, Gabrielle
and L Butryn, Meghan
and M Forman, Evan",
title="Remotely Delivered Behavioral Weight Loss Intervention Using an Ad Libitum Plant-Based Diet: Pilot Acceptability, Feasibility, and Preliminary Results",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="23",
volume="6",
number="6",
pages="e37414",
keywords="vegetarian diet",
keywords="vegan diet",
keywords="overweight",
keywords="eHealth",
keywords="behavioral intervention",
abstract="Background: Many traditional lifestyle interventions use calorie prescriptions, but most individuals have difficulty sustaining calorie tracking and thus weight loss. In contrast, whole food plant-based diets (WFPBDs) have previously shown significant weight loss without this issue. However, most WFPBD interventions are face-to-face and time-intensive, and do not leverage gold standard behavioral strategies for health behavior change. Objective: This open pilot trial was the first to evaluate the feasibility of a fully featured, remotely delivered behavioral weight loss intervention using an ad libitum WFPBD. Methods: Over 12 weeks, participants (N=15) with overweight or obesity received a newly designed program that integrated behavioral weight loss and a WFPBD prescription via weekly web-based modules and brief phone coaching calls. Assessments were performed at baseline, midtreatment (6 weeks), and after treatment (12 weeks). Results: The intervention was rated as highly acceptable (mean 4.40 out of 5, SE 0.18), and attrition was low (6.7\%). In all, intention-to-treat analyses revealed that 69\% (10.4/15) of the participants lost 5\% of their weight (mean --5.89, SE 0.68 kg). Predefined benchmarks for quality of life were met. Conclusions: A pilot digital behavioral weight loss intervention with a non--energy-restricted WFPBD was feasible, and the mean acceptability was high. Minimal contact time (80-150 minutes of study interventionist time per participant over 12 weeks) led to clinically relevant weight loss and dietary adherence for most participants (10.4/15, 69\% and 11.8/15, 79\%, respectively), and quality of life improvements (reliable change indices >1.53). We hope that this work will serve as a springboard for future larger scale randomized controlled studies evaluating the efficacy of such programs for weight loss, dietary change, and quality of life. Trial Registration: ClinicalTrials.gov NCT04892030; https://clinicaltrials.gov/ct2/show/NCT04892030 ",
doi="10.2196/37414",
url="https://formative.jmir.org/2022/6/e37414",
url="http://www.ncbi.nlm.nih.gov/pubmed/35737443"
}


@Article{info:doi/10.2196/36229,
author="Veldscholte, Karlien
and Cramer, G. Arnout B.
and de Jonge, J. Rogier C.
and Eveleens, D. Renate
and Joosten, M. Koenraad F.
and Verbruggen, T. Sascha C. A.",
title="Continuous Versus Intermittent Nutrition in Pediatric Intensive Care Patients: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="23",
volume="11",
number="6",
pages="e36229",
keywords="pediatric intensive care unit",
keywords="PICU",
keywords="pediatric critical illness",
keywords="time-restricted feeding",
keywords="intermittent fasting",
keywords="feeding intolerance",
keywords="ketones",
keywords="circadian rhythm",
abstract="Background: Intermittent fasting is a time-restricted feeding strategy with proven health benefits, which is based on multiple metabolic and endocrine changes, in several patient populations and healthy participants. In the pediatric intensive care unit (PICU), artificial feeding is usually administered 24 hours a day, although solid evidence supporting this practice is lacking. This discards the potential benefits of fasting in this population. We hypothesize that intermittent nutrition with a focus on an overnight feeding interruption (intermittent fasting), as compared with 24-hour continuous nutrition, is a feasible and safe strategy, with potential benefits, for critically ill children. Objective: The aim of the Continuous versus Intermittent Nutrition in Pediatric Intensive Care randomized controlled trial (RCT) is to investigate a strategy of intermittent nutrition with a focus on an overnight feeding interruption period versus 24-hour nutrition during the first 14 days in the PICU. Methods: The Continuous versus Intermittent Nutrition in Pediatric Intensive Care study is an investigator-initiated RCT in a tertiary referral PICU. Critically ill children (term newborn to 18 years), expected to stay in the PICU for ?48 hours, and dependent on artificial nutrition, are eligible for inclusion. This study will randomize critically ill children (n=140) to a continuous versus intermittent nutrition strategy. In both groups, similar daily caloric targets will be prescribed. In the continuous group (control), nutrition will be administered 24 hours a day, with a maximum interruption period of 2 hours. In the intermittent group (intervention), nutrition will be interrupted during an age-dependent overnight fasting period. The study intervention will last until admission day 14, initiation of oral intake, or discharge from the PICU, whichever comes first. The primary outcome is the difference in ketosis between the groups under the condition of noninferiority regarding caloric intake. Secondary outcomes are feeding intolerance; the proportion of severe and resistant hypoglycemic events and severe gastrointestinal complications; and additional observed effects on nutritional intake, circadian rhythm, and clinically relevant outcome measures of the intermittent feeding strategy compared with continuous nutrition. Results: The study was approved by the Dutch national ethical review board in February 2020. The first patient was enrolled on May 19, 2020. By May 2022, a total of 132 patients had been included in the study. Recruitment of the last patient is expected in Q3 2022. Conclusions: Although intermittent fasting has been proven to have many health benefits in both animal and human studies, the feasibility and safety of this strategy in a PICU setting must be investigated. This RCT will help physicians gain more insight into the feasibility, safety, and potential clinical effects of intermittent feeding with overnight fasting in critically ill children. Trial Registration: Netherlands Trial Register NL7877; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7877 International Registered Report Identifier (IRRID): DERR1-10.2196/36229 ",
doi="10.2196/36229",
url="https://www.researchprotocols.org/2022/6/e36229",
url="http://www.ncbi.nlm.nih.gov/pubmed/35737448"
}


@Article{info:doi/10.2196/33089,
author="Maddison, Ralph
and Baghaei, Nilufar
and Calder, Amanda
and Murphy, Rinki
and Parag, Varsha
and Heke, Ihirangi
and Dobson, Rosie
and Marsh, Samantha",
title="Feasibility of Using Games to Improve Healthy Lifestyle Knowledge in Youth Aged 9-16 Years at Risk for Type 2 Diabetes: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="17",
volume="6",
number="6",
pages="e33089",
keywords="children's health",
keywords="diabetes mellitus",
keywords="type 2 diabetes",
keywords="experimental games",
keywords="recruitment",
abstract="Background: Mobile games can be effective and motivating tools for promoting children's health. Objective: We aimed to determine the comparative use of 2 prototype serious games for health and assess their effects on healthy lifestyle knowledge in youth aged 9-16 years at risk for type 2 diabetes (T2D). Methods: A 3-arm parallel pilot randomized controlled trial was undertaken to determine the feasibility and preliminary effectiveness of 2 serious games. Feasibility aspects included recruitment, participant attitudes toward the games, the amount of time the participants played each game at home, and the effects of the games on healthy lifestyle and T2D knowledge. Participants were allocated to play Diabetic Jumper (n=7), Ari and Friends (n=8), or a control game (n=8). All participants completed healthy lifestyle and T2D knowledge questionnaires at baseline, immediately after game play, and 4 weeks after game play. Game attitudes and preferences were also assessed. The primary outcome was the use of the game (specifically, the number of minutes played over 4 weeks). Results: In terms of feasibility, we were unable to recruit our target of 60 participants. In total, 23 participants were recruited. Participants generally viewed the games positively. There were no statistical differences in healthy lifestyle knowledge or diabetes knowledge over time or across games. Only 1 participant accessed the game for an extended period, playing the game for a total of 33 min over 4 weeks. Conclusions: It was not feasible to recruit the target sample for this trial. The 2 prototype serious games were unsuccessful at sustaining long-term game play outside a clinic environment. Based on positive participant attitudes toward the games, it is possible to use these games or similar games as short-term stimuli to engage young people with healthy lifestyle and diabetes knowledge in a clinic setting; however, future research is required to explore this area. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619000380190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377123 ",
doi="10.2196/33089",
url="https://formative.jmir.org/2022/6/e33089",
url="http://www.ncbi.nlm.nih.gov/pubmed/35713955"
}


@Article{info:doi/10.2196/30630,
author="Okaniwa, Fusae
and Yoshida, Hiroshi",
title="Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="8",
volume="6",
number="6",
pages="e30630",
keywords="health promotion",
keywords="dietary management",
keywords="intervention",
keywords="artificial intelligence",
keywords="body fat percentage",
keywords="body mass index",
keywords="behavioral economics",
keywords="nonprofessional",
keywords="Japan",
abstract="Background: There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present. Objective: This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness. Methods: We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants' continuity and the effects on physical indicators. Results: Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5\% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP. Conclusions: This experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions. ",
doi="10.2196/30630",
url="https://formative.jmir.org/2022/6/e30630",
url="http://www.ncbi.nlm.nih.gov/pubmed/35675107"
}


@Article{info:doi/10.2196/35947,
author="Jacobi, Corinna
and Vollert, Bianka
and H{\"u}tter, Kristian
and von Bloh, Paula
and Eiterich, Nadine
and G{\"o}rlich, Dennis
and Taylor, Barr C.",
title="Indicated Web-Based Prevention for Women With Anorexia Nervosa Symptoms: Randomized Controlled Efficacy Trial",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="2",
volume="24",
number="6",
pages="e35947",
keywords="anorexia nervosa",
keywords="internet",
keywords="indicated prevention",
abstract="Background: Although preventive interventions for eating disorders in general have shown promise, interventions specifically targeting individuals at risk for anorexia nervosa (AN) are lacking. Objective: The aim of this study was to determine the efficacy of a guided, indicated web-based prevention program for women at risk for AN. Methods: We conducted a randomized controlled efficacy trial for women at risk for AN. Assessments were carried out at baseline (before the intervention), after the intervention (10 weeks after baseline), and at 6- and 12-month follow-ups (FUs). A total of 168 women with low body weight (17.5 kg/m2?BMI?19 kg/m2) and high weight concerns or with normal body weight (19 kg/m2<BMI?25 kg/m2), high weight concerns, and high restrained eating were recruited from 3 German universities as well as on the web and randomized to Student Bodies-AN (SB-AN; intervention group [IG]) or a wait-list control group (CG). The exclusion criteria were current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition--based full-syndrome eating disorders and serious medical or mental problems.?The interventions were a cognitive-behavioral guided web-based prevention program (SB-AN) over 10 weeks (IG) and a wait-list CG. The primary outcomes were clinically significant changes in disordered eating attitudes and behaviors and change in BMI at 12-month FU in the group of participants who were underweight. The secondary outcomes were new onset of eating disorders, symptoms of disordered eating, and associated psychopathology. Results: Data were available for 81.5\% (137/168) of the women after the intervention and for 69\% (116/168) of the women at 12-month FU. At 12-month FU, the IG participants showed larger decreases in Eating Disorder Examination total scores (38/48, 79\% vs 33/58, 57\%) than the CG participants and the IG participants who were underweight also showed larger clinically relevant increases in BMI (15/31, 49\% vs 10/32, 32\%) than the CG participants, but these differences were not significant. In addition, after the intervention and at 12-month FU, we found a significant increase in continuously measured BMI for the participants who were underweight and significant improvements in disordered eating attitudes and behaviors (eg, restrained eating as well as weight and shape concerns). At all time points, the rates of new-onset eating disorder cases were (nonsignificantly) lower in the IG than in the CG and the reductions in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition--based eating disorder syndromes were (nonsignificantly) higher in the IG than in the CG. Conclusions: SB-AN is the first preventive intervention shown to significantly reduce specific risk factors for, and symptoms of, AN and shows promise for reducing full-syndrome AN onset. Trial Registration: ISRCTN Registry ISRCTN70380261; https://www.isrctn.com/ISRCTN70380261 ",
doi="10.2196/35947",
url="https://www.jmir.org/2022/6/e35947",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653174"
}


@Article{info:doi/10.2196/38294,
author="Kilshaw, E. Robyn
and Adamo, Colin
and Butner, E. Jonathan
and Deboeck, R. Pascal
and Shi, Qinxin
and Bulik, M. Cynthia
and Flatt, E. Rachael
and Thornton, M. Laura
and Argue, Stuart
and Tregarthen, Jenna
and Baucom, W. Brian R.",
title="Passive Sensor Data for Characterizing States of Increased Risk for Eating Disorder Behaviors in the Digital Phenotyping Arm of the Binge Eating Genetics Initiative: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="2",
volume="11",
number="6",
pages="e38294",
keywords="digital phenotyping",
keywords="eating disorders",
keywords="personal digital devices",
keywords="methodology",
abstract="Background: Data that can be easily, efficiently, and safely collected via cell phones and other digital devices have great potential for clinical application. Here, we focus on how these data could be used to refine and augment intervention strategies for binge eating disorder (BED) and bulimia nervosa (BN), conditions that lack highly efficacious, enduring, and accessible treatments. These data are easy to collect digitally but are highly complex and present unique methodological challenges that invite innovative solutions. Objective: We describe the digital phenotyping component of the Binge Eating Genetics Initiative, which uses personal digital device data to capture dynamic patterns of risk for binge and purge episodes. Characteristic data signatures will ultimately be used to develop personalized models of eating disorder pathologies and just-in-time interventions to reduce risk for related behaviors. Here, we focus on the methods used to prepare the data for analysis and discuss how these approaches can be generalized beyond the current application. Methods: The University of North Carolina Biomedical Institutional Review Board approved all study procedures. Participants who met diagnostic criteria for BED or BN provided real time assessments of eating behaviors and feelings through the Recovery Record app delivered on iPhones and the Apple Watches. Continuous passive measures of physiological activation (heart rate) and physical activity (step count) were collected from Apple Watches over 30 days. Data were cleaned to account for user and device recording errors, including duplicate entries and unreliable heart rate and step values. Across participants, the proportion of data points removed during cleaning ranged from <0.1\% to 2.4\%, depending on the data source. To prepare the data for multivariate time series analysis, we used a novel data handling approach to address variable measurement frequency across data sources and devices. This involved mapping heart rate, step count, feeling ratings, and eating disorder behaviors onto simultaneous minute-level time series that will enable the characterization of individual- and group-level regulatory dynamics preceding and following binge and purge episodes. Results: Data collection and cleaning are complete. Between August 2017 and May 2021, 1019 participants provided an average of 25 days of data yielding 3,419,937 heart rate values, 1,635,993 step counts, 8274 binge or purge events, and 85,200 feeling observations. Analysis will begin in spring 2022. Conclusions: We provide a detailed description of the methods used to collect, clean, and prepare personal digital device data from one component of a large, longitudinal eating disorder study. The results will identify digital signatures of increased risk for binge and purge events, which may ultimately be used to create digital interventions for BED and BN. Our goal is to contribute to increased transparency in the handling and analysis of personal digital device data. Trial Registration: ClinicalTrials.gov NCT04162574; https://clinicaltrials.gov/ct2/show/NCT04162574 International Registered Report Identifier (IRRID): DERR1-10.2196/38294 ",
doi="10.2196/38294",
url="https://www.researchprotocols.org/2022/6/e38294",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653175"
}


@Article{info:doi/10.2196/35771,
author="Hammersley, L. Megan
and Wyse, J. Rebecca
and Jones, A. Rachel
and Okely, D. Anthony
and Wolfenden, Luke
and Eckermann, Simon
and Xu, Joe
and Green, Amanda
and Stacey, Fiona
and Yoong, Lin Sze
and Jackson, Jacklyn
and Innes-Hughes, Christine
and Li, Vincy
and Rissel, Chris",
title="Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial",
journal="J Med Internet Res",
year="2022",
month="May",
day="26",
volume="24",
number="5",
pages="e35771",
keywords="dietary intake",
keywords="physical activity",
keywords="screen time",
keywords="sleep",
keywords="movement behaviors",
keywords="online",
keywords="internet",
keywords="telephone",
keywords="mobile phone",
abstract="Background: Few translational trials have provided detailed reports of process evaluation results. Objective: This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Methods: Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants' intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Results: Data were collected from 458 participants in the baseline survey and 144 (31.4\%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. Conclusions: This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes. ",
doi="10.2196/35771",
url="https://www.jmir.org/2022/5/e35771",
url="http://www.ncbi.nlm.nih.gov/pubmed/35616994"
}


@Article{info:doi/10.2196/32270,
author="Rienecke, D. Renee
and Blalock, V. Dan
and Mills, D. Haley
and Duffy, Alan
and Manwaring, Jamie
and Le Grange, Daniel
and Mehler, S. Philip
and McClanahan, Susan
and Johnson, Craig",
title="Treatment Outcome for Adults in a Residential Program for Binge Eating Spectrum Disorders: Protocol for a Prospective Pragmatic Single-Arm Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="24",
volume="11",
number="5",
pages="e32270",
keywords="binge eating spectrum disorders",
keywords="binge eating disorder",
keywords="bulimia nervosa",
keywords="treatment",
keywords="residential program",
abstract="Background: Most studies reporting treatment outcomes for eating disorders at higher levels of care focus on anorexia nervosa and bulimia nervosa. No studies have been published with a singular focus on examining treatment outcomes for adults receiving residential programming specifically designed for the treatment of binge eating spectrum disorders (BESD), including binge eating disorder and bulimia nervosa. Objective: The purpose of this paper is to outline the protocol of a prospective study examining treatment outcomes at discharge and 3-month, 6-month, and 12-month postdischarge follow-up, for a sample of consecutive admissions to a residential program specifically for patients with BESD. Methods: One hundred consecutive admissions to a binge eating treatment program were enrolled in the prospective single-arm trial between January 2019 and February 2020. Data were collected at admission, discharge, and 3, 6, and 12 months postdischarge, with admission, discharge, and 12-month follow-up as the major timepoints of interest. Results across the major timepoints will be analyzed with mixed effects general linear models. Results: The primary aim is to assess the impact of the program on eating disordered behaviors at discharge and 12-month follow-up, which are hypothesized to improve as a result of treatment. Secondary hypotheses include improvements on comorbid symptoms, including trauma, depression, and obsessive-compulsive symptoms, as well as improvements on medical indicators of health, including cholesterol and triglycerides, at discharge and 12-month follow-up. Conclusions: This study may aid in the development of treatment guidelines for patients with BESD at higher levels of care and lend support to having specialty treatment programs for patients with BESD. International Registered Report Identifier (IRRID): DERR1-10.2196/32270 ",
doi="10.2196/32270",
url="https://www.researchprotocols.org/2022/5/e32270",
url="http://www.ncbi.nlm.nih.gov/pubmed/35608884"
}


@Article{info:doi/10.2196/33412,
author="Espinosa-Curiel, Edrein Ismael
and Pozas-Bogarin, Efr{\'e}n Edgar
and Hern{\'a}ndez-Arvizu, Maryleidi
and Navarro-Jim{\'e}nez, Elena Maria
and Delgado-P{\'e}rez, Emeth Edwin
and Mart{\'i}nez-Miranda, Juan
and P{\'e}rez-Espinosa, Humberto",
title="HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study",
journal="JMIR Serious Games",
year="2022",
month="May",
day="6",
volume="10",
number="2",
pages="e33412",
keywords="serious game",
keywords="children",
keywords="education and behavior change",
keywords="healthy lifestyle behaviors",
keywords="physical activity",
keywords="healthy eating",
keywords="socioemotional wellness",
abstract="Background: The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children. Objective: We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness. Methods: Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction. Results: Knowledge scores of intervention group participants increased from T0 to T1 for physical activity (t14=2.01, P=.03), healthy eating (t14=3.14, P=.003), and socioemotional wellness (t14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity (t14=2.82, P=.006), healthy eating (t14=3.44, P=.002), and socioemotional wellness (t14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group. Conclusions: HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend. ",
doi="10.2196/33412",
url="https://games.jmir.org/2022/2/e33412",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522474"
}


@Article{info:doi/10.2196/33663,
author="Pagoto, L. Sherry
and Schroeder, W. Matthew
and Xu, Ran
and Waring, E. Molly
and Groshon, Laurie
and Goetz, M. Jared
and Idiong, Christie
and Troy, Haley
and DiVito, Joseph
and Bannor, Richard",
title="A Facebook-Delivered Weight Loss Intervention Using Open Enrollment: Randomized Pilot Feasibility Trial",
journal="JMIR Form Res",
year="2022",
month="May",
day="6",
volume="6",
number="5",
pages="e33663",
keywords="weight loss",
keywords="obesity",
keywords="social media",
keywords="Facebook",
keywords="social networking",
keywords="mobile phone",
abstract="Background: Behavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes. Objective: In this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization. Methods: We conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m2. The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ?5\% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups. Results: Randomized participants (68/80, 85\% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m2. We enrolled an additional 54 participants (50/54, 93\% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88\% and 98\% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ?5\% was achieved by 30\% (12/40) of the participants randomized to the open enrollment condition and 18\% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1\% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics. Conclusions: Open enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial. Trial Registration: ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680 ",
doi="10.2196/33663",
url="https://formative.jmir.org/2022/5/e33663",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522466"
}


@Article{info:doi/10.2196/37126,
author="Grimes, Amanda
and Lightner, S. Joseph
and Eighmy, Katlyn
and Wray, D. Bridget
and Valleroy, Ella
and Baughn, Maya",
title="Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="4",
volume="11",
number="5",
pages="e37126",
keywords="intervention protocol",
keywords="physical activity",
keywords="food intake",
keywords="nutrition",
keywords="healthy eating",
keywords="middle schoolers",
keywords="youth",
keywords="school",
keywords="student",
keywords="fitness",
keywords="exercise",
keywords="food consumption",
keywords="diet",
keywords="fruit consumption",
keywords="vegetable consumption",
abstract="Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 ",
doi="10.2196/37126",
url="https://www.researchprotocols.org/2022/5/e37126",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507392"
}


@Article{info:doi/10.2196/35886,
author="Truman, Emily
and Elliott, Charlene",
title="Testing a Mobile App for Participatory Research to Identify Teen-Targeted Food Marketing: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="3",
volume="6",
number="5",
pages="e35886",
keywords="mHealth",
keywords="mobile app",
keywords="teenager",
keywords="adolescent",
keywords="monitoring",
keywords="participatory research",
keywords="feasibility",
keywords="usability",
keywords="food marketing",
keywords="food advertising",
abstract="Background: Mobile apps are not only effective tools for promoting health to teenagers but are also useful for engaging teenagers in participatory research on factors that influence their health. Given the impact of food marketing messages on teenagers' food attitudes and consumption choices, it is important to develop effective methods for capturing the food advertisements targeted at this population to assess their content. Objective: The aim of this study was to test the feasibility and usability of a mobile app, ``GrabFM!'' (``Grab Food Marketing!''), designed for teenagers to facilitate monitoring of self-identified targeted food marketing messaging. Methods: A mixed methods approach, including quantitative user response rates and qualitative focus group discussion feedback, was used in the evaluation process. Results: A total of 62 teenagers (ages 13-17) completed GrabFM! app pilot testing over a 7-day data collection period. Teenagers submitted a total of 339 examples of food marketing, suggesting high feasibility for the app. Participants also took part in focus group discussions about their experience, providing positive feedback on usability, including ease of use and design aesthetic appeal. Conclusions: The GrabFM! app had high feasibility and usability, suggesting its efficacy in capturing accurate data relevant to the teenage population's experience with food marketing messaging. ",
doi="10.2196/35886",
url="https://formative.jmir.org/2022/5/e35886",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503652"
}


@Article{info:doi/10.2196/29088,
author="Zenun Franco, Rodrigo
and Fallaize, Rosalind
and Weech, Michelle
and Hwang, Faustina
and Lovegrove, A. Julie",
title="Effectiveness of Web-Based Personalized Nutrition Advice for Adults Using the eNutri Web App: Evidence From the EatWellUK Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="25",
volume="24",
number="4",
pages="e29088",
keywords="personalized nutrition",
keywords="web-based",
keywords="nutrition app",
keywords="app",
keywords="dietary intervention",
keywords="eNutri",
keywords="precision nutrition",
keywords="mHealth",
keywords="healthy eating index",
keywords="diet quality scores",
keywords="FFQ",
keywords="food frequency questionnaire",
keywords="EatWellUK",
abstract="Background: Evidence suggests that eating behaviors and adherence to dietary guidelines can be improved using nutrition-related apps. Apps delivering personalized nutrition (PN) advice to users can provide individual support at scale with relatively low cost. Objective: This study aims to investigate the effectiveness of a mobile web app (eNutri) that delivers automated PN advice for improving diet quality, relative to general population food-based dietary guidelines. Methods: Nondiseased UK adults (aged >18 years) were randomized to PN advice or control advice (population-based healthy eating guidelines) in a 12-week controlled, parallel, single-blinded dietary intervention, which was delivered on the web. Dietary intake was assessed using the eNutri Food Frequency Questionnaire (FFQ). An 11-item US modified Alternative Healthy Eating Index (m-AHEI), which aligned with UK dietary and nutritional recommendations, was used to derive the automated PN advice. The primary outcome was a change in diet quality (m-AHEI) at 12 weeks. Participant surveys evaluated the PN report (week 12) and longer-term impact of the PN advice (mean 5.9, SD 0.65 months, after completion of the study). Results: Following the baseline FFQ, 210 participants completed at least 1 additional FFQ, and 23 outliers were excluded for unfeasible dietary intakes. The mean interval between FFQs was 10.8 weeks. A total of 96 participants were included in the PN group (mean age 43.5, SD 15.9 years; mean BMI 24.8, SD 4.4 kg/m2) and 91 in the control group (mean age 42.8, SD 14.0 years; mean BMI 24.2, SD 4.4 kg/m2). Compared with that in the control group, the overall m-AHEI score increased by 3.5 out of 100 (95\% CI 1.19-5.78) in the PN group, which was equivalent to an increase of 6.1\% (P=.003). Specifically, the m-AHEI components nuts and legumes and red and processed meat showed significant improvements in the PN group (P=.04). At follow-up, 64\% (27/42) of PN participants agreed that, compared with baseline, they were still following some (any) of the advice received and 31\% (13/42) were still motivated to improve their diet. Conclusions: These findings suggest that the eNutri app is an effective web-based tool for the automated delivery of PN advice. Furthermore, eNutri was demonstrated to improve short-term diet quality and increase engagement in healthy eating behaviors in UK adults, as compared with population-based healthy eating guidelines. This work represents an important landmark in the field of automatically delivered web-based personalized dietary interventions. Trial Registration: ClinicalTrials.gov NCT03250858; https://clinicaltrials.gov/ct2/show/NCT03250858 ",
doi="10.2196/29088",
url="https://www.jmir.org/2022/4/e29088",
url="http://www.ncbi.nlm.nih.gov/pubmed/35468093"
}


@Article{info:doi/10.2196/34704,
author="Kavanagh, E. Meaghan
and Chiavaroli, Laura
and Glenn, J. Andrea
and Heijmans, Genevieve
and Grant, M. Shannan
and Chow, Chi-Ming
and Josse, G. Robert
and Malik, S. Vasanti
and Watson, William
and Lofters, Aisha
and Holmes, Candice
and Rackal, Julia
and Srichaikul, Kristie
and Sherifali, Diana
and Snelgrove-Clarke, Erna
and Udell, A. Jacob
and Juni, Peter
and Booth, L. Gillian
and Farkouh, E. Michael
and Leiter, A. Lawrence
and Kendall, C. Cyril W.
and Jenkins, A. David J.
and Sievenpiper, L. John",
title="A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="21",
volume="9",
number="2",
pages="e34704",
keywords="portfolio diet",
keywords="dietary portfolio",
keywords="nutrition therapy",
keywords="dietary application",
keywords="eHealth",
keywords="usability testing",
keywords="quality improvement",
keywords="mobile phone",
abstract="Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective: The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users' perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users' perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users' needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool. ",
doi="10.2196/34704",
url="https://humanfactors.jmir.org/2022/2/e34704",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451981"
}


@Article{info:doi/10.2196/34962,
author="Kim, Hyeoneui
and Jung, Jinsun
and Choi, Jisung",
title="Developing a Dietary Lifestyle Ontology to Improve the Interoperability of Dietary Data: Proof-of-Concept Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="21",
volume="6",
number="4",
pages="e34962",
keywords="dietary lifestyle data",
keywords="person-generated health data",
keywords="ontology",
keywords="common data element",
keywords="data interoperability",
keywords="data standardization",
keywords="dietary",
keywords="health informatics",
abstract="Background: Dietary habits offer crucial information on one's health and form a considerable part of the patient-generated health data. Dietary data are collected through various channels and formats; thus, interoperability is a significant challenge to reusing this type of data. The vast scope of dietary concepts and the colloquial expression style add difficulty to standardizing the data. The interoperability issues of dietary data can be addressed through Common Data Elements with metadata annotation to some extent. However, making culture-specific dietary habits and questionnaire-based dietary assessment data interoperable still requires substantial efforts. Objective: The main goal of this study was to address the interoperability challenge of questionnaire-based dietary data from different cultural backgrounds by combining ontological curation and metadata annotation of dietary concepts. Specifically, this study aimed to develop a Dietary Lifestyle Ontology (DILON) and demonstrate the improved interoperability of questionnaire-based dietary data by annotating its main semantics with DILON. Methods: By analyzing 1158 dietary assessment data elements (367 in Korean and 791 in English), 515 dietary concepts were extracted and used to construct DILON. To demonstrate the utility of DILON in addressing the interoperability challenges of questionnaire-based multicultural dietary data, we developed 10 competency questions that asked to identify data elements sharing the same dietary topics and assessment properties. We instantiated 68 data elements on dietary habits selected from Korean and English questionnaires and annotated them with DILON to answer the competency questions. We translated the competency questions into Semantic Query-Enhanced Web Rule Language and reviewed the query results for accuracy. Results: DILON was built with 262 concept classes and validated with ontology validation tools. A small overlap (72 concepts) in the concepts extracted from the questionnaires in 2 languages indicates that we need to pay closer attention to representing culture-specific dietary concepts. The Semantic Query-Enhanced Web Rule Language queries reflecting the 10 competency questions yielded correct results. Conclusions: Ensuring the interoperability of dietary lifestyle data is a demanding task due to its vast scope and variations in expression. This study demonstrated that we could improve the interoperability of dietary data generated in different cultural contexts and expressed in various styles by annotating their core semantics with DILON. ",
doi="10.2196/34962",
url="https://formative.jmir.org/2022/4/e34962",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451991"
}


@Article{info:doi/10.2196/34967,
author="Yau, W. Kiana
and Tang, S. Tricia
and G{\"o}rges, Matthias
and Pinkney, Susan
and Kim, D. Annie
and Kalia, Angela
and Amed, Shazhan",
title="Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review",
journal="JMIR Pediatr Parent",
year="2022",
month="Mar",
day="28",
volume="5",
number="1",
pages="e34967",
keywords="childhood obesity",
keywords="mobile health",
keywords="health behaviors",
keywords="prevention",
keywords="study design",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. Objective: This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. Methods: MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. Results: Of the 13 studies identified, most used a quasi-experimental design (n=8, 62\%). Significant improvements in physical activity (4/8, 50\% studies), dietary outcomes (5/6, 83\% studies), and BMI (2/6, 33\% studies) were reported. All 6 multicomponent interventions and 57\% (4/7) of standalone interventions reported significant outcomes in ?1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. Conclusions: Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed. ",
doi="10.2196/34967",
url="https://pediatrics.jmir.org/2022/1/e34967",
url="http://www.ncbi.nlm.nih.gov/pubmed/35343908"
}


@Article{info:doi/10.2196/34946,
author="Castela Forte, Jos{\'e}
and Gannamani, Rahul
and Folkertsma, Pytrik
and Kumaraswamy, Sridhar
and Mount, Sarah
and van Dam, Sipko
and Hoogsteen, Jan",
title="Changes in Blood Lipid Levels After a Digitally Enabled Cardiometabolic Preventive Health Program: Pre-Post Study in an Adult Dutch General Population Cohort",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="23",
volume="6",
number="1",
pages="e34946",
keywords="cholesterol",
keywords="lifestyle intervention",
keywords="prevention",
keywords="hypercholesterolemia",
keywords="digital health",
abstract="Background: Despite widespread education, many individuals fail to follow basic health behaviors such as consuming a healthy diet and exercising. Positive changes in lifestyle habits are associated with improvements in multiple cardiometabolic health risk factors, including lipid levels. Digital lifestyle interventions have been suggested as a viable complement or potential alternative to conventional health behavior change strategies. However, the benefit of digital preventive interventions for lipid levels in a preventive health context remains unclear. Objective: This observational study aimed to determine how the levels of lipids, namely total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and triglycerides, changed over time in a Dutch general population cohort undergoing a digital preventive health program. Moreover, we looked to establish associations between lifestyle factors at baseline and lipid levels. Methods: We included 348 adults from the Dutch general population who underwent a digitally enabled preventive health program at Ancora Health between January 2020 and October 2021. Upon enrollment, participants underwent a baseline assessment involving a comprehensive lifestyle questionnaire, a blood biochemistry panel, physical measurements, and cardiopulmonary fitness measurements. Thereafter, users underwent a lifestyle coaching program and could access the digital application to register and track health behaviors, weight, and anthropometric data at any time. Lipid levels were categorized as normal, elevated, high, and clinical dyslipidemia according to accepted international standards. If at least one lipid marker was high or HDL was low, participants received specific coaching and advice for cardiometabolic health. We retrospectively analyzed the mean and percentage changes in lipid markers in users who were remeasured after a cardiometabolic health--focused intervention, and studied the association between baseline user lifestyle characteristics and having normal lipid levels. Results: In our cohort, 199 (57.2\%) participants had dyslipidemia at baseline, of which 104 participants were advised to follow a cardiometabolic health--focused intervention. Eating more amounts of favorable food groups and being more active were associated with normal lipid profiles. Among the participants who underwent remeasurement 9 months after intervention completion, 57\% (17/30), 61\% (19/31), 56\% (15/27), 82\% (9/11), and 100\% (8/8) showed improvements at remeasurement for total, LDL, HDL, and non-HDL cholesterol, and triglycerides, respectively. Moreover, between 35.3\% and 77.8\% showed a return to normal levels. In those with high lipid levels at baseline, total cholesterol decreased by 0.5 mmol/L (7.5\%), LDL cholesterol decreased by 0.39 mmol/L (10.0\%), non-HDL cholesterol decreased by 0.44 mmol/L (8.3\%), triglycerides decreased by 0.97 mmol/L (32.0\%), and HDL increased by 0.17 mmol/L (15.6\%), after the intervention. Conclusions: A cardiometabolic screening program in a general population cohort identified a significant portion of individuals with subclinical and clinical lipid levels. Individuals who, after screening, actively engaged in a cardiometabolic health--focused lifestyle program improved their lipid levels. ",
doi="10.2196/34946",
url="https://cardio.jmir.org/2022/1/e34946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319473"
}


@Article{info:doi/10.2196/24725,
author="Bonn, Stephanie
and Licitra, Gabriella
and Bellocco, Rino
and Trolle Lagerros, Ylva",
title="Clinical Outcomes Among Working Adults Using the Health Integrator Smartphone App: Analyses of Prespecified Secondary Outcomes in a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="21",
volume="24",
number="3",
pages="e24725",
keywords="adults",
keywords="body composition",
keywords="exercise",
keywords="HbA1c",
keywords="healthy lifestyle",
keywords="metabolic health",
keywords="mobile app",
keywords="randomized controlled trial",
keywords="smartphone",
abstract="Background: There is a need to find new methods that can enhance the individuals' engagement in self-care and increase compliance to a healthy lifestyle for the prevention of noncommunicable diseases and improved quality of life. Mobile health (mHealth) apps could provide large-scale, cost-efficient digital solutions to implement lifestyle change, which as a corollary may enhance quality of life. Objective: Here we evaluate if the use of a smartphone-based self-management system, the Health Integrator app, with or without telephone counseling by a health coach, had an effect on clinical variables (secondary outcomes) of importance for noncommunicable diseases. Methods: The study was a 3-armed parallel randomized controlled trial. Participants were randomized to a control group or to 1 of 2 intervention groups using the Health Integrator app with or without additional telephone counseling for 3 months. Clinical variables were assessed before the start of the intervention (baseline) and after 3 months. Due to the nature of the intervention, targeting lifestyle changes, participants were not blinded to their allocation. Robust linear regression with complete case analysis was performed to study the intervention effect among the intervention groups, both in the entire sample and stratifying by type of work (office worker vs bus driver) and sex. Results: Complete data at baseline and follow-up were obtained from 205 and 191 participants, respectively. The mean age of participants was 48.3 (SD 10) years; 61.5\% (126/205) were men and 52.2\% (107/205) were bus drivers. Improvements were observed at follow-up among participants in the intervention arms. There was a small statistically significant effect on waist circumference ($\beta$=--0.97, 95\% CI --1.84 to --0.10) in the group receiving the app and additional coach support compared to the control group, but no other statistically significant differences were seen. However, participants receiving only the app had statistically significantly lower BMI ($\beta$=--0.35, 95\% CI --0.61 to --0.09), body weight ($\beta$=--1.08, 95\% CI --1.92 to --0.26), waist circumference ($\beta$=--1.35, 95\% CI --2.24 to --0.45), and body fat percentage ($\beta$=--0.83, 95\% CI --1.65 to --0.02) at follow-up compared to the controls. There was a statistically significant difference in systolic blood pressure between the two intervention groups at follow-up ($\beta$=--3.74, 95\% CI --7.32 to --0.16); no other statistically significant differences in outcome variables were seen. Conclusions: Participants randomized to use the Health Integrator smartphone app showed small but statistically significant differences in body weight, BMI, waist circumference, and body fat percentage compared to controls after a 3-month intervention. The effect of additional coaching together with use of the app is unclear. Trial Registration: ClinicalTrials.gov NCT03579342; https://clinicaltrials.gov/ct2/show/NCT03579342 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6595-6 ",
doi="10.2196/24725",
url="https://www.jmir.org/2022/3/e24725",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311677"
}


@Article{info:doi/10.2196/33940,
author="Falkenhain, Kaja
and Locke, R. Sean
and Lowe, A. Dylan
and Lee, Terry
and Singer, Joel
and Weiss, J. Ethan
and Little, P. Jonathan",
title="Use of an mHealth Ketogenic Diet App Intervention and User Behaviors Associated With Weight Loss in Adults With Overweight or Obesity: Secondary Analysis of a Randomized Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="14",
volume="10",
number="3",
pages="e33940",
keywords="acetone",
keywords="biofeedback",
keywords="psychology",
keywords="diet",
keywords="ketogenic",
keywords="mobile apps",
keywords="overweight",
keywords="technology",
keywords="telemedicine",
keywords="weight loss",
keywords="mobile phone",
abstract="Background: Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile health (mHealth) apps allows for scalable and remote delivery of such dietary interventions and are increasingly being used by the general population without direct medical supervision. However, it is currently unknown which factors related to app use and user behavior are associated with successful weight loss. Objective: First, to describe and characterize user behavior, we aim to examine characteristics and user behaviors over time of participants who were enrolled in a remotely delivered clinical weight loss trial that tested an mHealth ketogenic diet app paired with a breath acetone biofeedback device. Second, to identify variables of importance to weight loss at 12 weeks that may offer insight for future development of dietary mHealth interventions, we aim to explore which app- and adherence-related user behaviors characterized successful weight loss. Methods: We analyzed app use and self-reported questionnaire data from 75 adults with overweight or obesity who participated in the intervention arm of a previous weight loss study. We examined data patterns over time through linear mixed models and performed correlation, linear regression, and causal mediation analyses to characterize diet-, weight-, and app-related user behavior associated with weight loss. Results: In the context of a low-carbohydrate ketogenic diet intervention delivered remotely through an mHealth app paired with a breath acetone biofeedback device, self-reported dietary adherence seemed to be the most important factor to predict weight loss ($\beta$=--.31; t54=--2.366; P=.02). Furthermore, self-reported adherence mediated the relationship between greater app engagement (from c=--0.008, 95\% CI --0.014 to --0.0019 to c'=--0.0035, 95\% CI --0.0094 to 0.0024) or higher breath acetone levels (from c=--1.34, 95\% CI --2.28 to --0.40 to c'=--0.40, 95\% CI --1.42 to 0.62) and greater weight loss, explaining a total of 27.8\% and 28.8\% of the variance in weight loss, respectively. User behavior (compliance with weight measurements and app engagement) and adherence-related aspects (breath acetone values and self-reported dietary adherence) over time differed between individuals who achieved a clinically significant weight loss of >5\% and those who did not. Conclusions: Our in-depth examination of app- and adherence-related user behaviors offers insight into factors associated with successful weight loss in the context of mHealth interventions. In particular, our finding that self-reported dietary adherence was the most important metric predicting weight loss may aid in the development of future mHealth dietary interventions. Trial Registration: ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707 International Registered Report Identifier (IRRID): RR2-10.2196/19053 ",
doi="10.2196/33940",
url="https://mhealth.jmir.org/2022/3/e33940",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285809"
}


@Article{info:doi/10.2196/35092,
author="Hopstock, Arnesdatter Laila
and Medin, Christine Anine
and Skeie, Guri
and Henriksen, Andr{\'e}
and Lundblad, Wasmuth Marie",
title="Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="11",
volume="6",
number="3",
pages="e35092",
keywords="system usability score",
keywords="older adults",
keywords="measurements",
keywords="nutrition",
keywords="dietary intake",
keywords="digital health",
keywords="web tool",
abstract="Background: A healthy diet throughout the life course improves health and reduces the risk of disease. There is a need for new knowledge of the relation between diet and health, but existing methods to collect information on food and nutrient intake have their limitations. Evaluations of new tools to assess dietary intake are needed, especially in old people, where the introduction of new technology might impose challenges. Objective: We aimed to examine the usability of a new web-based dietary assessment tool in older adult women and men. Methods: A total of 60 women and men (participation 83\%, 57\% women) aged 60-74 years recruited by convenience and snowball sampling completed a 24-hour web-based dietary recall using the newly developed Norwegian version of Measure Your Food On One Day (myfood24). Total energy and nutrient intakes were calculated in myfood24, primarily on the basis of the Norwegian Food Composition Table. No guidance or support was provided to complete the recall. Usability was assessed using the system usability scale (SUS), where an SUS score of ?68 was considered satisfactory. We examined the responses to single SUS items and the mean (SD) SUS score in groups stratified by sex, age, educational level, and device used to complete the recall (smartphone, tablet device, or computer). Results: The mean total energy intake was 5815 (SD 3093) kJ. A total of 14\% of participants had an energy intake of <2100 kJ (ie, 500 kilocalories) and none had an intake of >16,800 kJ (ie, 4000 kilocalories). Mean energy proportions from carbohydrates, fat, protein, alcohol, and fiber was within the national recommendations. The mean SUS score was 55.5 (SD 18.6), and 27\% of participants had SUS scores above the satisfactory product cut-off. Higher SUS scores were associated with younger age and lower education, but not with the type of device used. Conclusions: We found the overall usability of a new web-based dietary assessment tool to be less than satisfactory in accordance with standard usability criteria in a sample of 60-74--year-old Norwegians. The observed total energy intakes suggest that several of the participants underreported their intake during the completion of the dietary recall. Implementing web-based dietary assessment tools in older adults is feasible, but guidance and support might be needed to ensure valid completion. ",
doi="10.2196/35092",
url="https://formative.jmir.org/2022/3/e35092",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275079"
}


@Article{info:doi/10.2196/26374,
author="Kupila, E. Sakris K.
and Ven{\"a}l{\"a}inen, S. Mikko
and Suojanen, Laura-Unnukka
and Roseng{\aa}rd-B{\"a}rlund, Milla
and Ahola, J. Aila
and Elo, L. Laura
and Pietil{\"a}inen, H. Kirsi",
title="Weight Loss Trajectories in Healthy Weight Coaching: Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="9",
volume="6",
number="3",
pages="e26374",
keywords="acceptance and commitment therapy",
keywords="body weight",
keywords="eHealth",
keywords="obesity management",
keywords="real-life intervention",
keywords="web-based",
keywords="mobile phone",
abstract="Background: As global obesity prevalence continues to increase, there is a need for accessible and affordable weight management interventions, such as web-based programs. Objective: This paper aims to assess the outcomes of healthy weight coaching (HWC), a web-based obesity management program integrated into standard Finnish clinical care. Methods: HWC is an ongoing, structured digital 12-month program based on acceptance and commitment therapy. It includes weekly training sessions focused on lifestyle, general health, and psychological factors. Participants received remote one-on-one support from a personal coach. In this real-life, single-arm, prospective cohort study, we examined the total weight loss, weight loss profiles, and variables associated with weight loss success and program retention in 1189 adults (963 women) with a BMI >25 kg/m{\texttwosuperior} among participants of the program between October 2016 and March 2019. Absolute (kg) and relative (\%) weight loss from the baseline were the primary outcomes. We also examined the weight loss profiles, clustered based on the dynamic time-warping distance, and the possible variables associated with greater weight loss success and program retention. We compared different groups using the Mann-Whitney test or Kruskal-Wallis test for continuous variables and the chi-squared test for categorical variables. We analyzed changes in medication using the McNemar test. Results: Among those having reached the 12-month time point (n=173), the mean weight loss was 4.6\% (SE 0.5\%), with 43\% (n=75) achieving clinically relevant weight loss (?5\%). Baseline BMI ?40 kg/m{\texttwosuperior} was associated with a greater weight loss than a lower BMI (mean 6.6\%, SE 0.9\%, vs mean 3.2\%, SE 0.6\%; P=.02). In addition, more frequent weight reporting was associated with greater weight loss. No significant differences in weight loss were observed according to sex, age, baseline disease, or medication use. The total dropout rate was 29.1\%. Dropouts were slightly younger than continuers (47.2, SE 0.6 years vs 49.2, SE 0.4 years; P=.01) and reported their weight less frequently (3.0, SE 0.1 entries per month vs 3.3, SE 0.1 entries per month; P<.001). Conclusions: A comprehensive web-based program such as HWC is a potential addition to the repertoire of obesity management in a clinical setting. Heavier patients lost more weight, but weight loss success was otherwise independent of baseline characteristics. ",
doi="10.2196/26374",
url="https://formative.jmir.org/2022/3/e26374",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262494"
}


@Article{info:doi/10.2196/31533,
author="Sbardelotto, Jackson
and Martins, Birck B{\'a}rbara
and Buss, Caroline",
title="Use of Social Networks in the Context of the Dietitian's Practice in Brazil and Changes During the COVID-19 Pandemic: Exploratory Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="25",
volume="6",
number="2",
pages="e31533",
keywords="dietitian",
keywords="social networks",
keywords="nutrition",
keywords="health communication",
keywords="COVID-19",
keywords="social media",
keywords="Brazil",
keywords="perception",
keywords="health information",
keywords="usage",
keywords="behavior",
abstract="Background: Social networks have been pointed out as 1 of the greatest means of spreading information. A large part of the population is already present on these platforms, looking up subjects such as health, nutrition, and food. To reach this audience, it may be important for dietitians to explore social networks. However, there is a gap in scientific studies on exploring the ways in which these platforms are used by dietitians in Brazil, and the roles they play in the profession have not been well defined. Objective: This study aims to describe the roles that social networks play in dietitians' practice in Brazil and their mode of use of social networks. This study also aims to identify professionals' perceptions and opinions regarding the use of these tools, as well as changes in behavior on social network usage caused by the COVID-19 pandemic. Methods: We carried out a quantitative cross-sectional study, collecting data through an online questionnaire, submitted between October 2020 and January 2021 to dietitians registered on the Federal Council of Dietitians. All participants included in the study answered questions about the use of social networks in their professional context. Results: In total, 264 (91.7\%) of the 288 participants reported using social networks for professional practice. Instagram was the social network most often used by professionals (224/264, 84.8\%). Dietitians (N=288) related to the use of social networks (always to almost always) for sharing information about their services (n=114-72 [39.6\%-25\%], respectively), following the work of other dietitians (n=172-64 [59.7\%-22.2\%], respectively), and writing about topics related to food and nutrition (n=166-53 [57.6\%-18.4\%], respectively). The roles played by social networks in the professional context of dietitians were attracting more clients (210/289, 72.7\%) and keeping in touch with them (195/289, 67.5\%). Furthermore, 227 (78.5\%) of the 289 dietitians strongly agreed that social networks are good tools to promote their services. During the COVID-19 pandemic, 216 (74.7\%) of the 289 participants noticed changes in their behavior, feelings, or beliefs on the use of social networks related to professional practice, and 149 (51.6\%) have increased the frequency of sharing information about nutrition and health in general on social networks. Conclusions: The main roles of social networks in the professional context of dietitians are to attract clients and to facilitate the contact between professional and client. The modes of use reported by the professionals included sharing information about their services, following the work of professional colleagues, and writing about topics related to nutrition. Most of them reported believing that social networks are an effective way to disseminate their services. Moreover, most professionals claimed to have noticed changes in their behaviors or beliefs on social media during the COVID-19 pandemic. ",
doi="10.2196/31533",
url="https://formative.jmir.org/2022/2/e31533",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023837"
}


@Article{info:doi/10.2196/31530,
author="Lavikainen, Piia
and Mattila, Elina
and Absetz, Pilvikki
and Harjumaa, Marja
and Lindstr{\"o}m, Jaana
and J{\"a}rvel{\"a}-Reijonen, Elina
and Aittola, Kirsikka
and M{\"a}nnikk{\"o}, Reija
and Tilles-Tirkkonen, Tanja
and Lintu, Niina
and Lakka, Timo
and van Gils, Mark
and Pihlajam{\"a}ki, Jussi
and Martikainen, Janne",
title="Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="24",
volume="24",
number="2",
pages="e31530",
keywords="type 2 diabetes",
keywords="user engagement",
keywords="digital behavior change intervention",
keywords="trajectories",
keywords="habit formation",
keywords="mobile health",
abstract="Background: Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. Objective: We aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors. Methods: This is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors. Results: More than half (1022/1926, 53.1\%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9\%), weekly usage (731/1926, 38.0\%), twice weekly usage (208/1926, 10.8\%), and daily usage (83/1926, 4.3\%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months. Conclusions: Distinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions. Trial Registration: ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6574-y ",
doi="10.2196/31530",
url="https://www.jmir.org/2022/2/e31530",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200147"
}


@Article{info:doi/10.2196/30211,
author="Bell, Marie Brooke
and Alam, Ridwan
and Mondol, Sayeed Abu
and Ma, Meiyi
and Emi, Afrin Ifat
and Preum, Masud Sarah
and de la Haye, Kayla
and Stankovic, A. John
and Lach, John
and Spruijt-Metz, Donna",
title="Validity and Feasibility of the Monitoring and Modeling Family Eating Dynamics System to Automatically Detect In-field Family Eating Behavior: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="18",
volume="10",
number="2",
pages="e30211",
keywords="ecological momentary assessment",
keywords="wearable sensors",
keywords="automatic dietary assessment",
keywords="eating behavior",
keywords="eating context",
keywords="smartwatch",
keywords="mobile phone",
abstract="Background: The field of dietary assessment has a long history, marked by both controversies and advances. Emerging technologies may be a potential solution to address the limitations of self-report dietary assessment methods. The Monitoring and Modeling Family Eating Dynamics (M2FED) study uses wrist-worn smartwatches to automatically detect real-time eating activity in the field. The ecological momentary assessment (EMA) methodology was also used to confirm whether eating occurred (ie, ground truth) and to measure other contextual information, including positive and negative affect, hunger, satiety, mindful eating, and social context. Objective: This study aims to report on participant compliance (feasibility) to the 2 distinct EMA protocols of the M2FED study (hourly time-triggered and eating event--triggered assessments) and on the performance (validity) of the smartwatch algorithm in automatically detecting eating events in a family-based study. Methods: In all, 20 families (58 participants) participated in the 2-week, observational, M2FED study. All participants wore a smartwatch on their dominant hand and responded to time-triggered and eating event--triggered mobile questionnaires via EMA while at home. Compliance to EMA was calculated overall, for hourly time-triggered mobile questionnaires, and for eating event--triggered mobile questionnaires. The predictors of compliance were determined using a logistic regression model. The number of true and false positive eating events was calculated, as well as the precision of the smartwatch algorithm. The Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation were used to determine whether there were differences in the detection of eating events by participant age, gender, family role, and height. Results: The overall compliance rate across the 20 deployments was 89.26\% (3723/4171) for all EMAs, 89.7\% (3328/3710) for time-triggered EMAs, and 85.7\% (395/461) for eating event--triggered EMAs. Time of day (afternoon odds ratio [OR] 0.60, 95\% CI 0.42-0.85; evening OR 0.53, 95\% CI 0.38-0.74) and whether other family members had also answered an EMA (OR 2.07, 95\% CI 1.66-2.58) were significant predictors of compliance to time-triggered EMAs. Weekend status (OR 2.40, 95\% CI 1.25-4.91) and deployment day (OR 0.92, 95\% CI 0.86-0.97) were significant predictors of compliance to eating event--triggered EMAs. Participants confirmed that 76.5\% (302/395) of the detected events were true eating events (ie, true positives), and the precision was 0.77. The proportion of correctly detected eating events did not significantly differ by participant age, gender, family role, or height (P>.05). Conclusions: This study demonstrates that EMA is a feasible tool to collect ground-truth eating activity and thus evaluate the performance of wearable sensors in the field. The combination of a wrist-worn smartwatch to automatically detect eating and a mobile device to capture ground-truth eating activity offers key advantages for the user and makes mobile health technologies more accessible to nonengineering behavioral researchers. ",
doi="10.2196/30211",
url="https://mhealth.jmir.org/2022/2/e30211",
url="http://www.ncbi.nlm.nih.gov/pubmed/35179508"
}


@Article{info:doi/10.2196/33603,
author="Carpenter, A. Chelsea
and Eastman, Abraham
and Ross, M. Kathryn",
title="Consistency With and Disengagement From Self-monitoring of Weight, Dietary Intake, and Physical Activity in a Technology-Based Weight Loss Program: Exploratory Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="18",
volume="6",
number="2",
pages="e33603",
keywords="self-monitoring",
keywords="adherence",
keywords="weight loss",
keywords="digital tools",
keywords="mobile phone",
abstract="Background: Digital self-monitoring tools offer promise to improve adherence to self-monitoring of weight and weight-related behaviors; however, less is known regarding the patterns of participant consistency and disengagement with these tools. Objective: This study characterizes the consistency of use and time to disengagement with digital self-monitoring tools during a 6-month weight loss intervention and investigates whether the provision of phone-based intervention improved self-monitoring adherence. Methods: Participants were 54 adults with overweight or obesity (mean age 49.6 years, SD 12.4 years; mean BMI 32.6 kg/m2, SD 3.2 kg/m2) enrolled in a pilot trial assessing the impact of self-monitoring technology (Fitbit Zip, Aria scale, and smartphone app), with and without additional interventionist contact, on weight loss. All participants received weight loss education and were asked to self-monitor weight, dietary intake, and physical activity daily throughout the 6-month program. Consistency was defined as the number of weeks that participants adhered to self-monitoring recommendations (7 out of 7 days). Disengagement was defined as the first of 2 consecutive weeks that the 7-day self-monitoring adherence goal was not met. Wilcoxon signed-rank tests were used to examine differences in consistency and disengagement by behavioral targets. t tests (2-tailed) and Cox proportional hazards models were used to examine whether providing additional interventionist contact would lead to significant improvements in consistency and time to disengagement from self-monitoring tools, respectively. Linear regressions were used to examine associations between consistency, time to disengagement, and weight loss. Results: Participants consistently self-monitored physical activity for more weeks (mean 17.4 weeks, SD 8.5 weeks) than weight (mean 11.1 weeks, SD 8.5 weeks) or dietary intake (mean 10.8 weeks, SD 8.7 weeks; P<.05). Similarly, participants had a significantly longer time to disengagement from self-monitoring of physical activity (median 19.5 weeks) than weight (4 weeks) or dietary intake (10 weeks; P<.001). Participants randomized to receive additional interventionist contact had significantly greater consistency and longer time to disengagement for self-monitoring of dietary intake compared with participants who did not (P=.006); however, there were no statistically significant differences between groups for self-monitoring of weight or physical activity (P=.24 and P=.25, respectively). Greater consistency and longer time to disengagement were associated with greater weight loss for self-monitoring of weight and dietary intake (P<.001 and P=.004, respectively) but not for physical activity (P=.57). Conclusions: Results demonstrated that self-monitoring adherence differed by behavioral target, with greater consistency and longer time to disengagement associated with lower-burden tools (ie, self-monitoring of physical activity). Consistent with supportive accountability theory, additional interventionist contact improved consistency and lengthened time to disengagement from self-monitoring of dietary intake. Given the observed associations between consistency, disengagement, and weight loss outcomes, it is important to identify additional methods of increasing consistency and engagement with digital self-monitoring tools. ",
doi="10.2196/33603",
url="https://formative.jmir.org/2022/2/e33603",
url="http://www.ncbi.nlm.nih.gov/pubmed/35179513"
}


@Article{info:doi/10.2196/31537,
author="Brown, Marie Jacqueline
and Franco-Arellano, Beatriz
and Froome, Hannah
and Siddiqi, Amina
and Mahmood, Amina
and Arcand, JoAnne",
title="The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="16",
volume="10",
number="2",
pages="e31537",
keywords="mHealth",
keywords="children",
keywords="app quality",
keywords="behavior change techniques",
keywords="child nutrition",
keywords="mobile apps",
keywords="Canada",
keywords="mobile phone",
abstract="Background: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods: This analysis used a cross-sectional database of nutrition-themed apps intended for children (?12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50\%) and as not recommended (8/16, 50\%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9\%). Results: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5\% (162/259) of apps were classified as food games, 27.4\% (71/259) as didactic nutrition guides, 6.6\% (17/259) as habit trackers, and 3.5\% (9/259) as other. Most apps (198/259, 76.4\%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps ($\beta$=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7\%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT. ",
doi="10.2196/31537",
url="https://mhealth.jmir.org/2022/2/e31537",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171100"
}


@Article{info:doi/10.2196/30675,
author="Kouvari, Matina
and Karipidou, Melina
and Tsiampalis, Thomas
and Mamalaki, Eirini
and Poulimeneas, Dimitrios
and Bathrellou, Eirini
and Panagiotakos, Demosthenes
and Yannakoulia, Mary",
title="Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="14",
volume="24",
number="2",
pages="e30675",
keywords="childhood obesity",
keywords="eHealth",
keywords="mHealth",
keywords="digital health",
keywords="youth",
keywords="mobile phone",
abstract="Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference --0.61, 95\% CI --1.10 to --0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference --0.36, 95\% CI --0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. ",
doi="10.2196/30675",
url="https://www.jmir.org/2022/2/e30675",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156934"
}


@Article{info:doi/10.2196/35164,
author="Tang, Hao
and Kim, Sungwoo
and Laforet, E. Priscila
and Tettey, Naa-Solo
and Basch, H. Corey",
title="Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="9",
volume="6",
number="2",
pages="e35164",
keywords="COVID-19",
keywords="quarantine",
keywords="weight loss",
keywords="weight gain",
keywords="social media",
keywords="YouTube",
abstract="Background: Many people experienced unintended weight gain during the COVID-19 pandemic, which has been discussed widely on social media. Objective: This study aims to describe the content of weight loss videos on YouTube (Google LLC) during the COVID-19 pandemic. Methods: By using the keywords weight loss during quarantine, the 100 most viewed English-language videos were identified and coded for content related to losing weight gained during the COVID-19 pandemic. Results: In total, 9 videos were excluded due to having non-English content or posting data before the COVID-19 pandemic. The 91 videos included in the study sample acquired 407,326 views at the time of study and were roughly 14 minutes long. A total of 48\% (44/91) of the sample videos included graphic comparisons to illustrate weight change. Videos that included a graphic comparison were more likely to have content related to trigger warnings ($\chi$21=6.05; P=.01), weight loss ($\chi$21=13.39; P<.001), negative feelings during quarantine ($\chi$21=4.75; P=.03), instructions for losing weight ($\chi$21=9.17; P=.002), self-love ($\chi$21=6.01; P=.01), body shaming ($\chi$21=4.36; P=.04), and special dietary practices ($\chi$21=11.10; P<.001) but were less likely to include food recipes ($\chi$21=5.05; P=.03). Our regression analysis results suggested that mentioning quarantine (P=.05), fat-gaining food (P=.04), self-care and self-love (P=.05), and body shaming (P=.008) and having presenters from both sexes (P<.001) are significant predictors for a higher number of views. Our adjusted regression model suggested that videos with content about routine change have significantly lower view counts (P=.03) than those of videos without such content. Conclusions: The findings of this study indicate the ways in which YouTube is being used to showcase COVID-19--related weight loss in a pre-post fashion. The use of graphic comparisons garnered a great deal of attention. Additional studies are needed to understand the role of graphic comparisons in social media posts. Further studies that focus on people's attitudes and behaviors toward weight change during the COVID-19 pandemic and the implications of social media on these attitudes and behaviors are warranted. ",
doi="10.2196/35164",
url="https://formative.jmir.org/2022/2/e35164",
url="http://www.ncbi.nlm.nih.gov/pubmed/34978534"
}


@Article{info:doi/10.2196/29537,
author="Rosas, G. Lisa
and Lv, Nan
and Xiao, Lan
and Azar, MJ Kristen
and Hooker, P. Steven
and Venditti, M. Elizabeth
and Lewis, A. Megan
and Zavella, Patricia
and Ma, Jun",
title="Preferences for Technology-Mediated Behavioral Lifestyle Interventions With Different Levels of Coach and Peer Support Among Latino Men: Comparative Study Within One Arm of a Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="4",
volume="6",
number="2",
pages="e29537",
keywords="Latino men's health",
keywords="technology-mediated behavioral interventions",
keywords="weight management",
keywords="mobile phone",
abstract="Background: Although Latino men have the highest prevalence (45\%) of obesity among all men in the United States, traditional weight loss interventions have not effectively engaged this hard-to-reach and diverse group. Offering choices among technology-mediated weight loss interventions may offer advantages. Objective: The aim of this study is to examine Latino men's preferences among 3 weight loss intervention options. We also examined whether attendance in group sessions (videoconference and in person) and weight loss differed according to intervention choice. Methods: Latino men (n=200; mean age 47.3, SD 11.8 years) participated in a comparative effectiveness trial based on primary care and were randomized to receive the 1-year HOMBRE (Hombres con Opciones para Mejorar su Bienestar para Reducir Enfermedades Cr{\'o}nicas; English translation: Men With Options to Improve Their Well-being and Reduce Chronic Disease) intervention. HOMBRE is a weight loss intervention that offers 3 delivery options. During an orientation session, a trained bilingual coach helped men select 1 of the 3 intervention options that differed in coach, peer support, and available language. We used canonical discriminant analysis to assess multivariate associations of demographic, clinical, employment, cultural, and technology use and access factors with men's intervention choices. We used generalized linear models to estimate weight loss at 6, 12, and 18 months for men in each intervention option. Results: Among Latino men, 28\% (56/200) chose videoconference groups, 31\% (62/200) chose web-based videos, and 41\% (82/200) chose in-person groups. The canonical discriminant analysis identified 1 orthogonal dimension that distinguished between men who chose an in-person group and men who chose web-based videos. Men who were older, spoke Spanish, and did not use a computer frequently had a higher probability of choosing in-person groups versus web-based videos. For men who selected a group delivery option, 86.9\% (107/123) attended ?25\% of the sessions, 83.7\% (103/123) attended ?50\% of the sessions, and 73.2\% (90/123) attended ?75\% of the sessions, with no differences by type of group (videoconference or in person). Men who chose videoconference and in-person group sessions lost significantly more weight at 6 months (both P<.001) and 18 months (P=.02 and P=.04, respectively) than those who chose web-based videos. Men who chose in-person group sessions also lost significantly more weight at 12 months (P=.008) than those who chose web-based videos. Conclusions: There were significant differences according to demographic, employment, cultural, and technology use factors between men who chose 1 of the 3 intervention options. Men who chose one of the group-based options (videoconference or in person) lost significantly more weight than those who chose web-based videos. Providing options that accommodate the diversity of Latino men's preferences is important for increasing engagement in behavioral interventions. Trial Registration: ClinicalTrials.gov NCT03092960; https://clinicaltrials.gov/ct2/show/NCT03092960 ",
doi="10.2196/29537",
url="https://formative.jmir.org/2022/2/e29537",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119377"
}


@Article{info:doi/10.2196/31184,
author="Griauzde, H. Dina
and Ling, Grace
and Wray, Daniel
and DeJonckheere, Melissa
and Mizokami Stout, Kara
and Saslow, R. Laura
and Fenske, Jill
and Serlin, David
and Stonebraker, Spring
and Nisha, Tabassum
and Barry, Colton
and Pop-Busui, Rodica
and Sen, Ananda
and Richardson, R. Caroline",
title="Continuous Glucose Monitoring With Low-Carbohydrate Nutritional Coaching to Improve Type 2 Diabetes Control: Randomized Quality Improvement Program",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e31184",
keywords="type 2 diabetes mellitus",
keywords="continuous glucose monitoring",
keywords="low-carbohydrate counseling",
abstract="Background: Type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality globally, with adverse health consequences largely related to hyperglycemia. Despite clinical practice guideline recommendations, effective pharmacotherapy, and interventions to support patients and providers, up to 60\% of patients diagnosed with T2DM are estimated to have hemoglobin A1c (HbA1c) levels above the recommended targets owing to multilevel barriers hindering optimal glycemic control. Objective: The aim of this study is to compare changes in HbA1c levels among patients with suboptimally controlled T2DM who were offered the opportunity to use an intermittently viewed continuous glucose monitor and receive personalized low-carbohydrate nutrition counseling (<100 g/day) versus those who received usual care (UC). Methods: This was a 12-month, pragmatic, randomized quality improvement program. All adult patients with T2DM who received primary care at a university-affiliated primary care clinic (N=1584) were randomized to either the UC or the enhanced care (EC) group. Within each program arm, we identified individuals with HbA1c >7.5\% (58 mmol/mol) who were medically eligible for tighter glycemic control, and we defined these subgroups as UC--high risk (UC-HR) or EC-HR. UC-HR participants (n=197) received routine primary care. EC-HR participants (n=185) were invited to use an intermittently viewed continuous glucose monitor and receive low-carbohydrate nutrition counseling. The primary outcome was mean change in HbA1c levels from baseline to 12 months using an intention-to-treat difference-in-differences analysis comparing EC-HR with UC-HR groups. We conducted follow-up semistructured interviews to understand EC-HR participant experiences with the intervention. Results: HbA1c decreased by 0.41\% (4.5 mmol/mol; P=.04) more from baseline to 12 months among participants in the EC-HR group than among those in UC-HR; however, only 61 (32.9\%) of 185 EC-HR participants engaged in the program. Among the EC-HR participants who wore continuous glucose monitors (61/185, 32.9\%), HbA1c was 1.1\% lower at 12 months compared with baseline (P<.001). Interviews revealed themes related to EC-HR participants' program engagement and continuous glucose monitor use. Conclusions: Among patients with suboptimally controlled T2DM, a combined approach that includes continuous glucose monitoring and low-carbohydrate nutrition counseling can improve glycemic control compared with the standard of care. ",
doi="10.2196/31184",
url="https://www.jmir.org/2022/2/e31184",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107429"
}


@Article{info:doi/10.2196/30416,
author="Lugones-Sanchez, Cristina
and Recio-Rodriguez, I. Jose
and Agudo-Conde, Cristina
and Repiso-Gento, Irene
and G Adalia, Esther
and Ramirez-Manent, Ignacio Jos{\'e}
and Sanchez-Calavera, Antonia Maria
and Rodriguez-Sanchez, Emiliano
and Gomez-Marcos, A. Manuel
and Garcia-Ortiz, Luis
and ",
title="Long-term Effectiveness of a Smartphone App Combined With a Smart Band on Weight Loss, Physical Activity, and Caloric Intake in a Population With Overweight and Obesity (Evident 3 Study): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="1",
volume="24",
number="2",
pages="e30416",
keywords="mobile app",
keywords="telemedicine",
keywords="eHealth",
keywords="weight control",
keywords="exercise",
keywords="obesity",
keywords="mobile phone",
abstract="Background: Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. Objective: This study aims to evaluate the long-term effectiveness (12 months) of a multicomponent mobile health intervention---combining a smartphone app, an activity tracker wristband, and brief counseling, compared with a brief counseling group only---on weight loss and improving body composition, physical activity, and caloric intake in Spanish sedentary adults with overweight or obesity. Methods: We conducted a randomized controlled, multicenter clinical trial (Evident 3). A total of 650 participants were recruited from 5 primary care centers, with 318 participants in the intervention group (IG) and 332 in the control group (CG). All participants were briefly counseled about a healthy diet and physical activity at the baseline visit. For the 3-month intervention period, the IG received training to use the app to promote healthy lifestyles and the smart band (Mi Band 2, Xiaomi). All measurements were performed at baseline and at 3 and 12 months. Physical activity was measured using the International Physical Activity Questionnaire--Short Form. Nutritional habits were assessed using the Food Frequency Questionnaire and Adherence to Mediterranean diet questionnaire. Results: Of the 650 participants included, 563 (86.6\%) completed the 3-month visit and 443 (68.2\%) completed the 12-month visit. After 12 months, the IG showed net differences in weight (?0.26, 95\% CI ?1.21 to 0.70 kg; P=.02), BMI (?0.06, 95\% CI ?0.41 to 0.28 points; P=.01), waist-height ratio (?0.25, 95\% CI ?0.94 to 0.44; P=.03), body adiposity index (?0.33, 95\% CI ?0.77 to 0.11; P=.03), waist circumference (?0.48, 95\% CI ?1.62 to 0.66 cm, P=.04) and hip circumference (?0.69, 95\% CI --1.62 to 0.25 cm; P=.03). Both groups lowered daily caloric intake and increased adherence to the Mediterranean diet, with no differences between the groups. The IG increased light physical activity time (32.6, 95\% CI ?30.3 to 95.04 min/week; P=.02) compared with the CG. Analyses by subgroup showed changes in body composition variables in women, people aged >50 years, and married people. Conclusions: The low-intensity intervention of the Evident 3 study showed, in the IG, benefits in weight loss, some body composition variables, and time spent in light physical activity compared with the CG at 3 months, but once the devices were collected, the downward trend was not maintained at the 12-month follow-up. No differences in nutritional outcomes were observed between the groups. Trial Registration: ClinicalTrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614 International Registered Report Identifier (IRRID): RR2-10.1097/MD.0000000000009633 ",
doi="10.2196/30416",
url="https://www.jmir.org/2022/2/e30416",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103609"
}


@Article{info:doi/10.2196/30566,
author="Duan, Yanping
and Liang, Wei
and Wang, Yanping
and Lippke, Sonia
and Lin, Zhihua
and Shang, Borui
and Baker, Steven Julien",
title="The Effectiveness of Sequentially Delivered Web-Based Interventions on Promoting Physical Activity and Fruit-Vegetable Consumption Among Chinese College Students: Mixed Methods Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e30566",
keywords="web-based intervention",
keywords="physical activity",
keywords="fruit-vegetable consumption",
keywords="college students",
keywords="health action process approach",
keywords="mixed methods",
keywords="quantitative research",
keywords="qualitative research",
abstract="Background: Web-based interventions for multiple health behavior change (MHBC) appear to be a promising approach to change unhealthy habits. Limited research has tested this assumption in promoting physical activity (PA) and fruit-vegetable consumption (FVC) among Chinese college students. Moreover, the timing of MHBC intervention delivery and the order of components need to be addressed. Objective: This study aims to examine the effectiveness of 2 sequentially delivered 8-week web-based interventions on physical activity, FVC, and health-related outcomes (BMI, depression, and quality of life) and the differences in the intervention effects between the 2 sequential delivery patterns. The study also aims to explore participants' experiences of participating in the health program. Methods: We conducted a randomized controlled trial, in which 552 eligible college students (mean 19.99, SD 1.04 years, 322/552, 58.3\% female) were randomly assigned to 1 of 3 groups: PA-first group (4 weeks of PA followed by 4 weeks of FVC intervention), FVC-first group (4 weeks of FVC followed by 4 weeks of PA intervention), and a control group (8 weeks of placebo treatment unrelated to PA and FVC). The treatment content of two intervention groups was designed based on the Health Action Process Approach (HAPA) framework. A total of four web-based assessments were conducted: at baseline (T1, n=565), after 4 weeks (T2, after the first behavior intervention, n=486), after 8 weeks (T3, after the second behavior intervention, n=420), and after 12 weeks (T4, 1-month postintervention follow-up, n=348). In addition, after the completion of the entire 8-week intervention, 18 participants (mean 19.56, SD 1.04 years, 10/18, 56\% female) who completed the whole program were immediately invited to attend one-to-one and face-to-face semistructured interviews. The entire study was conducted during the fall semester of 2017. Results: The quantitative data supported superior effects on physical activity, FVC, and BMI in the 2 sequential intervention groups compared with the control group. There were no significant differences in physical activity, FVC, and health-related outcomes between the 2 intervention groups after 8 weeks. The FVC-first group contributed to more maintenance of FVC compared with the PA-first group after 12 weeks. Four major themes with several subthemes were identified in the qualitative thematic analysis: PA and FVC behavior, health-related outcomes, correlates of behavior change, and contamination detection. Conclusions: This study provides empirical evidence for the effectiveness of sequentially delivered, web-based MHBC interventions on PA and FVC among Chinese college students. The timing issue of MHBC intervention delivery was preliminarily addressed. Qualitative findings provide an in-depth understanding and supplement the quantitative findings. Overall, this study may contribute considerably to future web-based MHBC interventions. Trial Registration: ClinicalTrials.gov NCT03627949; https://clinicaltrials.gov/ct2/show/NCT03627949 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7438-1 ",
doi="10.2196/30566",
url="https://www.jmir.org/2022/1/e30566",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080497"
}


@Article{info:doi/10.2196/29669,
author="Favaretti, Caterina
and Vandormael, Alain
and Hachaturyan, Violetta
and Greuel, Merlin
and Gates, Jennifer
and B{\"a}rnighausen, Till
and Adam, Maya",
title="Participant Engagement and Reactance to a Short, Animated Video About Added Sugars: Web-based Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="24",
volume="8",
number="1",
pages="e29669",
keywords="added sugar",
keywords="prevention",
keywords="sugar consumption",
keywords="short and animated story-based video",
keywords="informational video",
keywords="randomized controlled trial",
keywords="social media",
keywords="participant engagement",
keywords="health promotion",
keywords="United Kingdom",
keywords="entertainment",
keywords="patient education",
keywords="healthy eating",
keywords="preventive health",
keywords="health messaging",
abstract="Background: Short, animated story-based (SAS) videos are a novel and promising strategy for promoting health behaviors. To gain traction as an effective health communication tool, SAS videos must demonstrate their potential to engage a diverse and global audience. In this study, we evaluate engagement with a SAS video about the consumption of added sugars, which is narrated by a child (a nonthreatening character), a mother (a neutral layperson), or a physician (a medical expert). Objective: This study aims to (1) assess whether engagement with the sugar intervention video differs by narrator type (child, mother, physician) and trait proneness to reactance and (2) assess whether the demographic characteristics of the participants (age, gender, education status) are associated with different engagement profiles with the sugar intervention video. Methods: In December 2020, after 4013 participants from the United Kingdom completed our randomized controlled trial, we offered participants assigned to the placebo arms (n=1591, 39.65\%) the choice to watch the sugar intervention video (without additional compensation) as posttrial access to treatment. We measured engagement as the time that participants chose to watch the 3.42-minute video and collected data on age, gender, education status, and trait reactance proneness. Using ordinary least squares regression, we quantified the association of the demographic characteristics and trait reactance proneness with the sugar video view time. Results: Overall, 66.43\% (n=1047) of the 1576 participants in the 2 placebo arms voluntarily watched the sugar intervention video. The mean view time was 116.35 (52.4\%) of 222 seconds. Results show that view times did not differ by narrator (child, mother, physician) and that older participants (aged 25-59 years, mean = 125.2 seconds) watched the sugar video longer than younger adults (aged 18-25 years, mean = 83.4 seconds). View time remained consistent across education levels. Participants with low trait reactance (mean = 119.3 seconds) watched the intervention video longer than high-trait-reactance participants (mean = 95.3 seconds), although this association did not differ by narrator type. Conclusions: The majority of participants in our study voluntarily watched more than half of the sugar intervention video, which is a promising finding. Our results suggest that SAS videos may need to be shorter than 2 minutes to engage people who are young or have high trait proneness to reactance. We also found that the choice of narrator (child, mother, or physician) for our video did not significantly affect participant engagement. Future videos, aimed at reaching diverse audiences, could be customized for different age groups, where appropriate. Trial Registration: German Clinical Trials Register DRKS00022340; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00022340 International Registered Report Identifier (IRRID): RR2-10.2196/25343 ",
doi="10.2196/29669",
url="https://publichealth.jmir.org/2022/1/e29669",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072639"
}


@Article{info:doi/10.2196/30682,
author="Jung, Jiyeon
and Cho, Inhae",
title="Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="21",
volume="10",
number="1",
pages="e30682",
keywords="mHealth",
keywords="physical activity",
keywords="obesity",
keywords="weight loss",
keywords="workforce",
keywords="workplace health promotion",
keywords="mobile phone",
abstract="Background: Physical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear. Objective: This study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers. Methods: We searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics. Results: A total of 8 studies were included in this analysis. More than half of the studies (5/8, 63\%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95\% CI 0.03-0.41; P<.001; I2=78\%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95\% CI --0.07 to 0.10; P=.48; I2=0\%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95\% CI 0.21-1.19; P<.001; I2=83.3\%), a multicomponent program (SMD 0.19, 95\% CI 0.05-0.33; P=.03; I2=57.4\%), objective measurement (SMD 0.58, 95\% CI 0.05-1.10; P<.001; I2=87.3\%), and 2 or more delivery modes (SMD 0.44, 95\% CI 0.01-0.87; P<.001; I2=85.1\%) were significantly associated with an enhancement in PA. Conclusions: This study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended. ",
doi="10.2196/30682",
url="https://mhealth.jmir.org/2022/1/e30682",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060913"
}


@Article{info:doi/10.2196/34546,
author="Myers-Ingram, Richard
and Sampford, Jade
and Milton-Cole, Rhian
and Jones, David Gareth",
title="Outcomes Following eHealth Weight Management Interventions in Adults With Overweight and Obesity From Low Socioeconomic Groups: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="20",
volume="11",
number="1",
pages="e34546",
keywords="obesity",
keywords="eHealth",
keywords="technology",
keywords="weight management",
keywords="weight loss",
keywords="low socioeconomic status",
keywords="socioeconomic",
keywords="systematic review",
keywords="weight",
keywords="obese",
abstract="Background: Obesity is a complex health condition with multiple associated comorbidities and increased economic costs. People from low socioeconomic status (SES) backgrounds are more likely to be overweight and obese and are less successful in traditional weight management programs. It is possible that eHealth interventions may be more successful in reaching people from low SES groups than traditional face-to-face models, by overcoming certain barriers associated with traditional interventions. It is not yet known, however, if eHealth weight management interventions are effective in people living with overweight and obesity from a low SES background. Objective: The primary aim of this study is to evaluate the efficacy of eHealth weight management interventions for people with overweight and obesity from low SES groups. Methods: A systematic review on relevant electronic databases (MEDLINE, Embase, Emcare, and CINAHL) will be undertaken to identify eligible studies published in English up until May 2021. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to guide the systematic review, two reviewers will independently screen, select, and extract data and complete a risk of bias assessment of search results according to predefined criteria. Studies that have investigated an eHealth weight management intervention within a low SES population will be included. Primary outcomes include weight, BMI, and percentage weight change compared at baseline and at least one other time point. Secondary outcomes may include a range of anthropometric and physical fitness and activity measures. If sufficient studies are homogeneous, then we will pool results of individual outcomes using meta-analysis. Results: Searches have been completed, resulting in 2256 studies identified. Once duplicates were removed, 1545 studies remained for title and abstract review. Conclusions: The use of eHealth in weight management programs has increased significantly in recent years and will continue to do so; however, it is uncertain if eHealth weight management programs are effective in a low SES population. The results of this systematic review will therefore provide a summary of the evidence for interventions using eHealth for people living with overweight and obesity and from a low SES background. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021243973; https://tinyurl.com/2p8fxtnw International Registered Report Identifier (IRRID): DERR1-10.2196/34546 ",
doi="10.2196/34546",
url="https://www.researchprotocols.org/2022/1/e34546",
url="http://www.ncbi.nlm.nih.gov/pubmed/35049506"
}


@Article{info:doi/10.2196/31989,
author="Smart, H. Mary
and Nabulsi, A. Nadia
and Gerber, S. Ben
and Gupta, Itika
and Di Eugenio, Barbara
and Ziebart, Brian
and Sharp, K. Lisa",
title="A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="19",
volume="6",
number="1",
pages="e31989",
keywords="mHealth",
keywords="Fitbit",
keywords="SMART goals",
keywords="texting",
keywords="health coach",
keywords="mobile phone",
abstract="Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91\%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70\% (23/33) of participants presenting as obese. A total of 30\% (9/30) of participants self-rated their health as either fair or poor, and 73\% (22/30) of participants set up ?6 weekly goals across the 8-week program. In total, 93\% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17\% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. ",
doi="10.2196/31989",
url="https://formative.jmir.org/2022/1/e31989",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044308"
}


@Article{info:doi/10.2196/28003,
author="Chan, W. William
and Fitzsimmons-Craft, E. Ellen
and Smith, C. Arielle
and Firebaugh, Marie-Laure
and Fowler, A. Lauren
and DePietro, Bianca
and Topooco, Naira
and Wilfley, E. Denise
and Taylor, Barr C.
and Jacobson, C. Nicholas",
title="The Challenges in Designing a Prevention Chatbot for Eating Disorders: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="19",
volume="6",
number="1",
pages="e28003",
keywords="chatbot",
keywords="eating disorders",
keywords="digital mental health",
keywords="prevention",
keywords="intervention development",
abstract="Background: Chatbots have the potential to provide cost-effective mental health prevention programs at scale and increase interactivity, ease of use, and accessibility of intervention programs. Objective: The development of chatbot prevention for eating disorders (EDs) is still in its infancy. Our aim is to present examples of and solutions to challenges in designing and refining a rule-based prevention chatbot program for EDs, targeted at adult women at risk for developing an ED. Methods: Participants were 2409 individuals who at least began to use an EDs prevention chatbot in response to social media advertising. Over 6 months, the research team reviewed up to 52,129 comments from these users to identify inappropriate responses that negatively impacted users' experience and technical glitches. Problems identified by reviewers were then presented to the entire research team, who then generated possible solutions and implemented new responses. Results: The most common problem with the chatbot was a general limitation in understanding and responding appropriately to unanticipated user responses. We developed several workarounds to limit these problems while retaining some interactivity. Conclusions: Rule-based chatbots have the potential to reach large populations at low cost but are limited in understanding and responding appropriately to unanticipated user responses. They can be most effective in providing information and simple conversations. Workarounds can reduce conversation errors. ",
doi="10.2196/28003",
url="https://formative.jmir.org/2022/1/e28003",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044314"
}


@Article{info:doi/10.2196/31875,
author="Sasaki, Yuki
and Sato, Koryu
and Kobayashi, Satomi
and Asakura, Keiko",
title="Nutrient and Food Group Prediction as Orchestrated by an Automated Image Recognition System in a Smartphone App (CALO mama): Validation Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="10",
volume="6",
number="1",
pages="e31875",
keywords="health app",
keywords="image recognition",
keywords="automatic calculation",
keywords="nutrient and food contents",
keywords="validity",
keywords="mobile phone",
keywords="mHealth",
keywords="validation",
keywords="nutrition",
keywords="diet",
keywords="food",
abstract="Background: A smartphone image recognition app is expected to be a novel tool for measuring nutrients and food intake, but its performance has not been well evaluated. Objective: We assessed the accuracy of the performance of an image recognition app called CALO mama in terms of the nutrient and food group contents automatically estimated by the app. Methods: We prepared 120 meal samples for which the nutrients and food groups were calculated. Next, we predicted the nutrients and food groups included in the meals from their photographs by using (1) automated image recognition only and (2) manual modification after automatic identification. Results: Predictions generated using only image recognition were similar to the actual data on the weight of meals and were accurate for 11 out of 30 nutrients and 4 out of 15 food groups. The app underestimated energy, 19 nutrients, and 9 food groups, while it overestimated dairy products and confectioneries. After manual modification, the predictions were similar for energy, accurately capturing the nutrients for 29 out of 30 of meals and the food groups for 10 out of 15 meals. The app underestimated pulses, fruits, and meats, while it overestimated weight, vitamin C, vegetables, and confectioneries. Conclusions: The results of this study suggest that manual modification after prediction using image recognition improves the performance of the app in assessing the nutrients and food groups of meals. Our findings suggest that image recognition has the potential to achieve a description of the dietary intakes of populations by using ``precision nutrition'' (a comprehensive and dynamic approach to developing tailored nutritional recommendations) for individuals. ",
doi="10.2196/31875",
url="https://formative.jmir.org/2022/1/e31875",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006077"
}


@Article{info:doi/10.2196/30352,
author="Veps{\"a}l{\"a}inen, Henna
and Skaffari, Essi
and Wojtkowska, Katarzyna
and Barli?ska, Julia
and Kinnunen, Satu
and Makkonen, Riikka
and Heikkil{\"a}, Maria
and Lehtovirta, Mikko
and Ray, Carola
and Suhonen, Eira
and Nevalainen, Jaakko
and Sajaniemi, Nina
and Erkkola, Maijaliisa",
title="A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="4",
volume="10",
number="1",
pages="e30352",
keywords="gamification",
keywords="intervention",
keywords="behavior change",
keywords="health game",
keywords="games for health",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce. Objective: This paper describes the development of the Mole's Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years. Methods: A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children's willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children's willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up. Results: A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52\%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95\% CI 1.41-13.03) than the control group (106/221, 48\%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95\% CI 0.05-0.52). Conclusions: The Mole's Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments. Trial Registration: ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283 ",
doi="10.2196/30352",
url="https://mhealth.jmir.org/2022/1/e30352",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982718"
}


@Article{info:doi/10.2196/30578,
author="Krukowski, Rebecca
and Johnson, Brandi
and Kim, Hyeonju
and Sen, Saunak
and Homsi, Riad",
title="A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="24",
volume="5",
number="12",
pages="e30578",
keywords="pregnancy",
keywords="weight",
keywords="physical activity",
keywords="self-weighing",
abstract="Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2{\texttimes}2{\texttimes}2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine's GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks' gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62\%) were Black or African American, 30 (77\%) were not married, and 29 (74\%) had an annual household income of less than US \$50,000. Of the 39 participants, 35 (90\%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive--based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive--based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 ",
doi="10.2196/30578",
url="https://formative.jmir.org/2021/12/e30578",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951594"
}


@Article{info:doi/10.2196/30909,
author="Braakhuis, Andrea
and Gillies, Nicola
and Worthington, Anna
and Knowles, Scott
and Conner, Tamlin
and Roy, Rajshri
and Pham, Toan
and Bermingham, Emma
and Cameron-Smith, David",
title="A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="21",
volume="10",
number="12",
pages="e30909",
keywords="protein",
keywords="meat",
keywords="vegetarian",
keywords="eating patterns",
keywords="diet",
keywords="nutrition",
keywords="dietary restrictions",
keywords="biomarkers",
keywords="health",
keywords="well-being",
keywords="macronutrients",
keywords="micronutrients",
abstract="Background: The trend of flexitarian eating patterns is on the rise, with young adults among the biggest adopters claiming health and environmental reasons to reduce red meat intake. Nutrient-dense meat and animal products are often the lynchpin of these diets, even when consumed only occasionally and in moderate amounts. Red meat provides forms and concentrations of essential proteins, lipids, and micronutrients that are scarce in exclusively vegetarian regimens. Objective: The aim of this study is to consider the effects of moderate consumption of lean red meat as part of an otherwise vegetarian balanced diet and its impact on biomarkers of sustained health and well-being. Methods: A cohort of healthy, young (20-34 years old, n=80) male and female participants will take part in a 2-arm, parallel randomized controlled trial (RCT) for a duration of 12 weeks, with a 3-month posttrial follow-up. The trial will commence with a 2-week assessment period followed by allocation to the intervention arms. The intervention will include the consumption of red meat or meat alternatives 3 times per week for 10 weeks. Blood samples of the participants will be collected to measure changes in erythrocyte fatty acid distribution, circulating amino acids, neurotransmitters, markers of mineral status, and inflammatory markers. Questionnaires to assess well-being and mental health will be undertaken every 2 weeks. Body composition, physical function, and blood parameters will be assessed at allocation (t0), week 5 into the intervention (t5), and post intervention (t10). Results: The protocol has been developed using the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) checklist and the outcomes will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial was approved by the New Zealand Ministry of Health's Health and Disability Ethics Committees (protocol 20/STH/157). The results of this study will be communicated via publication. Conclusions: To our knowledge, this is the first RCT investigating the overarching health consequences of consuming pasture-fed red meat or no meat as part of a healthy diet. Trial Registration: ClinicalTrials.gov NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163 International Registered Report Identifier (IRRID): PRR1-10.2196/30909 ",
doi="10.2196/30909",
url="https://www.researchprotocols.org/2021/12/e30909",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931994"
}


@Article{info:doi/10.2196/25902,
author="Barnes, Courtney
and Yoong, Lin Sze
and Nathan, Nicole
and Wolfenden, Luke
and Wedesweiler, Taya
and Kerr, Jayde
and Ward, S. Dianne
and Grady, Alice",
title="Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="15",
volume="23",
number="12",
pages="e25902",
keywords="childcare center",
keywords="web-based",
keywords="nutrition",
keywords="healthy eating",
keywords="randomized controlled trial",
keywords="intervention",
keywords="implementation",
abstract="Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children's healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47\%) provided consent to participate. Data collection components were completed by 100\% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91\% to 11/11, 100\%) and the web-based program (11/11, 100\%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91\% to 11/11, 100\%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19\% (2/11) to 64\% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w ",
doi="10.2196/25902",
url="https://www.jmir.org/2021/12/e25902",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914617"
}


@Article{info:doi/10.2196/32441,
author="Kay, C. Melissa
and Hammad, M. Nour
and Herring, J. Sharon
and Bennett, G. Gary",
title="Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="15",
volume="10",
number="12",
pages="e32441",
keywords="WIC",
keywords="diet quality",
keywords="digital health",
keywords="text messaging",
keywords="mothers",
keywords="postpartum",
keywords="child obesity",
keywords="mobile phone",
abstract="Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ?2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants' diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 ",
doi="10.2196/32441",
url="https://www.researchprotocols.org/2021/12/e32441",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914616"
}


@Article{info:doi/10.2196/26988,
author="Taylor, Salima
and Korpusik, Mandy
and Das, Sai
and Gilhooly, Cheryl
and Simpson, Ryan
and Glass, James
and Roberts, Susan",
title="Use of Natural Spoken Language With Automated Mapping of Self-reported Food Intake to Food Composition Data for Low-Burden Real-time Dietary Assessment: Method Comparison Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="6",
volume="23",
number="12",
pages="e26988",
keywords="energy intake",
keywords="macronutrient intakes",
keywords="24-hour recall",
keywords="machine learning",
keywords="convolutional neural networks",
keywords="nutrition",
keywords="diet",
keywords="app",
keywords="natural language processing",
abstract="Background: Self-monitoring food intake is a cornerstone of national recommendations for health, but existing apps for this purpose are burdensome for users and researchers, which limits use. Objective: We developed and pilot tested a new app (COCO Nutritionist) that combines speech understanding technology with technologies for mapping foods to appropriate food composition codes in national databases, for lower-burden and automated nutritional analysis of self-reported dietary intake. Methods: COCO was compared with the multiple-pass, interviewer-administered 24-hour recall method for assessment of energy intake. COCO was used for 5 consecutive days, and 24-hour dietary recalls were obtained for two of the days. Participants were 35 women and men with a mean age of 28 (range 20-58) years and mean BMI of 24 (range 17-48) kg/m2. Results: There was no significant difference in energy intake between values obtained by COCO and 24-hour recall for days when both methods were used (mean 2092, SD 1044 kcal versus mean 2030, SD 687 kcal, P=.70). There were also no significant differences between the methods for percent of energy from protein, carbohydrate, and fat (P=.27-.89), and no trend in energy intake obtained with COCO over the entire 5-day study period (P=.19). Conclusions: This first demonstration of a dietary assessment method using natural spoken language to map reported foods to food composition codes demonstrates a promising new approach to automate assessments of dietary intake. ",
doi="10.2196/26988",
url="https://www.jmir.org/2021/12/e26988",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874885"
}


@Article{info:doi/10.2196/27512,
author="Harrington, Katharine
and Zenk, N. Shannon
and Van Horn, Linda
and Giurini, Lauren
and Mahakala, Nithya
and Kershaw, N. Kiarri",
title="The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="2",
volume="5",
number="12",
pages="e27512",
keywords="ecological momentary assessment",
keywords="eating behaviors",
keywords="crowdsourcing",
keywords="food consumption images",
keywords="food image processing",
keywords="mobile phone",
abstract="Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility---usability and acceptability---of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85\%) and high agreement for all other food categories (871/1014, 85.89\% for fruits; 847/1014, 83.53\% for salty snacks, and 833/1014, 81.15\% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. ",
doi="10.2196/27512",
url="https://formative.jmir.org/2021/12/e27512",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860666"
}


@Article{info:doi/10.2196/22390,
author="Coumans, J. Juul M.
and Oenema, Anke
and Bolman, W. Catherine A.
and Lechner, Lilian",
title="Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="2",
volume="5",
number="12",
pages="e22390",
keywords="diet",
keywords="physical activity",
keywords="eHealth",
keywords="self-determination theory",
keywords="motivational interviewing",
keywords="process evaluation",
keywords="nonusage attrition",
abstract="Background: eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions. Objective: This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants' flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores. Methods: This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores. Results: Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6\%), the PA module (2/12, 17\%), and both modules (58/273, 21.2\%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions). Conclusions: This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study. ",
doi="10.2196/22390",
url="https://formative.jmir.org/2021/12/e22390",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860670"
}


@Article{info:doi/10.2196/31734,
author="Wyse, Rebecca
and Delaney, Tessa
and Stacey, Fiona
and Lecathelinais, Christophe
and Ball, Kylie
and Zoetemeyer, Rachel
and Lamont, Hannah
and Sutherland, Rachel
and Nathan, Nicole
and Wiggers, H. John
and Wolfenden, Luke",
title="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 Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="29",
volume="23",
number="11",
pages="e31734",
keywords="child diet",
keywords="consumer behavior",
keywords="intervention",
keywords="RCT",
keywords="public health nutrition",
keywords="obesity",
keywords="school",
keywords="school canteen",
keywords="long-term follow-up",
keywords="choice architecture",
keywords="public health",
keywords="nutrition",
keywords="children",
keywords="diet",
keywords="eHealth",
keywords="school lunch",
abstract="Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075 ",
doi="10.2196/31734",
url="https://www.jmir.org/2021/11/e31734",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847063"
}


@Article{info:doi/10.2196/31307,
author="Hopkins, M. Christina
and Miller, N. Hailey
and Brooks, L. Taylor
and Mo-Hunter, Lihua
and Steinberg, M. Dori
and Bennett, G. Gary",
title="Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="25",
volume="10",
number="11",
pages="e31307",
keywords="obesity",
keywords="stigma",
keywords="mHealth",
keywords="mindfulness",
keywords="self-compassion",
keywords="mobile phone",
abstract="Background: Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. Objective: Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. Methods: Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. Results: The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. Conclusions: Ruby will be the first digital standalone, self-compassion--based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. Trial Registration: ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973 International Registered Report Identifier (IRRID): DERR1-10.2196/31307 ",
doi="10.2196/31307",
url="https://www.researchprotocols.org/2021/11/e31307",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842549"
}


@Article{info:doi/10.2196/30160,
author="Prowse, Rachel
and Carsley, Sarah",
title="Digital Interventions to Promote Healthy Eating in Children: Umbrella Review",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="25",
volume="4",
number="4",
pages="e30160",
keywords="children",
keywords="healthy eating",
keywords="eHealth",
keywords="nutrition intervention",
keywords="nutrition education",
keywords="food literacy",
keywords="digital health",
keywords="virtual delivery",
keywords="digital interventions",
keywords="nutrition interventions",
keywords="best practices",
keywords="education",
keywords="mobile phone",
abstract="Background: eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. Objective: The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). Methods: We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. Results: In total, 11 systematic reviews published since 2015 were included (7/11, 64\%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. Conclusions: Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children. ",
doi="10.2196/30160",
url="https://pediatrics.jmir.org/2021/4/e30160",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842561"
}


@Article{info:doi/10.2196/29664,
author="Hachaturyan, Violetta
and Adam, Maya
and Favaretti, Caterina
and Greuel, Merlin
and Gates, Jennifer
and B{\"a}rnighausen, Till
and Vandormael, Alain",
title="Reactance to Social Authority in a Sugar Reduction Informational Video: Web-Based Randomized Controlled Trial of 4013 Participants",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="22",
volume="23",
number="11",
pages="e29664",
keywords="sugar reduction",
keywords="reactance",
keywords="animated video",
keywords="digital intervention",
keywords="health communication",
abstract="Background: Short and animated story-based (SAS) videos can be an effective strategy for promoting health messages. However, health promotion strategies often motivate the rejection of health messages, a phenomenon known as reactance. In this study, we examine whether the child narrator of a SAS video (perceived as nonthreatening, with low social authority) minimizes reactance to a health message about the consumption of added sugars. Objective: This study aims to determine whether our SAS intervention video attenuates reactance to the sugar message when compared with a content placebo video (a health message about sunscreen) and a placebo video (a nonhealth message about earthquakes) and determine if the child narrator is more effective at reducing reactance to the sugar message when compared with the mother narrator (equivalent social authority to target audience) or family physician narrator (high social authority) of the same SAS video. Methods: This is a web-based randomized controlled trial comparing an intervention video about sugar reduction narrated by a child, the child's mother, or the family physician with a content placebo video about sunscreen use and a placebo video about earthquakes. The primary end points are differences in the antecedents to reactance (proneness to reactance, threat level of the message), its components (anger and negative cognition), and outcomes (source appraisal and attitude). We performed analysis of variance on data collected (N=4013) from participants aged 18 to 59 years who speak English and reside in the United Kingdom. Results: Between December 9 and December 11, 2020, we recruited 38.62\% (1550/4013) men, 60.85\% (2442/4013) women, and 0.52\% (21/4013) others for our study. We found a strong causal relationship between the persuasiveness of the content promoted by the videos and the components of reactance. Compared with the placebo (mean 1.56, SD 0.63) and content placebo (mean 1.76, SD 0.69) videos, the intervention videos (mean 1.99, SD 0.83) aroused higher levels of reactance to the message content (P<.001). We found no evidence that the child narrator (mean 1.99, SD 0.87) attenuated reactance to the sugar reduction message when compared with the physician (mean 1.95, SD 0.79; P=.77) and mother (mean 2.03, SD 0.83; P=.93). In addition, the physician was perceived as more qualified, reliable, and having more expertise than the child (P<.001) and mother (P<.001) narrators. Conclusions: Although children may be perceived as nonthreatening messengers, we found no evidence that a child narrator attenuated reactance to a SAS video about sugar consumption when compared with a physician. Furthermore, our intervention videos, with well-intended goals toward audience health awareness, aroused higher levels of reactance when compared with the placebo videos. Our results highlight the challenges in developing effective interventions to promote persuasive health messages. Trial Registration: German Clinical Trials Registry DRKS00022340; https://tinyurl.com/mr8dfena International Registered Report Identifier (IRRID): RR2-10.2196/25343 ",
doi="10.2196/29664",
url="https://www.jmir.org/2021/11/e29664",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813490"
}


@Article{info:doi/10.2196/26252,
author="Pant, Ichhya
and Rimal, Rajiv
and Yilma, Hagere
and Bingenheimer, Jeffrey
and Sedlander, Erica
and Behera, Sibabrata",
title="mHealth for Anemia Reduction: Protocol for an Entertainment Education--Based Dual Intervention",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="22",
volume="10",
number="11",
pages="e26252",
keywords="mHealth",
keywords="interactive",
keywords="voice response",
keywords="entertainment",
keywords="education",
keywords="rural",
keywords="anemia",
keywords="bystander",
keywords="violence against women",
abstract="Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India's burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education--based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women--related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study's primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms--based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women--related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 ",
doi="10.2196/26252",
url="https://www.researchprotocols.org/2021/11/e26252",
url="http://www.ncbi.nlm.nih.gov/pubmed/34812735"
}


@Article{info:doi/10.2196/29003,
author="Park, Jihyun
and Park, Mi-Jeong
and Seo, Young-Gyun",
title="Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="17",
volume="23",
number="11",
pages="e29003",
keywords="ICT",
keywords="eHealth",
keywords="mHealth",
keywords="weight loss",
keywords="obesity",
keywords="BMI",
keywords="meta-analysis",
keywords="randomized controlled trial",
keywords="children",
keywords="adolescents",
keywords="mobile phone",
abstract="Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=?1.26 kg/m2, 95\% CI ?2.24 to ?0.28), lifestyle modification comparator (WMD=?1.75, 95\% CI ?2.76 to ?0.74), intervention involving both boys and girls (WMD=?1.30, 95\% CI ?2.14 to ?0.46), and intervention involving obesity only (WMD=?1.92, 95\% CI ?3.75 to ?0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. ",
doi="10.2196/29003",
url="https://www.jmir.org/2021/11/e29003",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787572"
}


@Article{info:doi/10.2196/26931,
author="Chatterjee, Ayan
and Prinz, Andreas
and Gerdes, Martin
and Martinez, Santiago",
title="Digital Interventions on Healthy Lifestyle Management: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="17",
volume="23",
number="11",
pages="e26931",
keywords="eHealth",
keywords="digital intervention",
keywords="lifestyle",
keywords="obesity",
keywords="challenges",
keywords="mobile phone",
abstract="Background: Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. Objective: This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). Methods: We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. Results: Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. Conclusions: This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions. ",
doi="10.2196/26931",
url="https://www.jmir.org/2021/11/e26931",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787575"
}


@Article{info:doi/10.2196/28185,
author="Ang, Min Siew
and Chen, Juliana
and Liew, Huan Jia
and Johal, Jolyn
and Dan, Young Yock
and Allman-Farinelli, Margaret
and Lim, Lin Su",
title="Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="16",
volume="23",
number="11",
pages="e28185",
keywords="systematic review",
keywords="meta-analysis",
keywords="mobile app",
keywords="obesity",
keywords="weight loss",
keywords="Asian",
keywords="diet",
keywords="physical activity",
keywords="adults",
keywords="mobile phone",
abstract="Background: Smartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem. Objective: This systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population. Methods: A total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors. Results: A total of 21 studies were included in this review, and 17 (81\%) were selected for the meta-analysis. The pooled effect size across 82\% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=--0.26; 95\% CI --0.41 to --0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=--0.28; 95\% CI --0.47 to --0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes. Conclusions: More evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management. Trial Registration: PROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6 ",
doi="10.2196/28185",
url="https://www.jmir.org/2021/11/e28185",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783674"
}


@Article{info:doi/10.2196/31611,
author="Nuruddin, Rozina
and Vadsaria, Khadija
and Mohammed, Nuruddin
and Sayani, Saleem",
title="The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="16",
volume="10",
number="11",
pages="e31611",
keywords="coaching",
keywords="compliance",
keywords="diet",
keywords="maternal health",
keywords="mobile health",
keywords="offspring health",
keywords="physical activity",
keywords="pregnancy",
keywords="supplement use",
keywords="usability",
abstract="Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program's effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We  expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 ",
doi="10.2196/31611",
url="https://www.researchprotocols.org/2021/11/e31611",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783675"
}


@Article{info:doi/10.2196/28024,
author="Cyriac, Jissy
and Jenkins, Sarah
and Patten, A. Christi
and Hayes, N. Sharonne
and Jones, Clarence
and Cooper, A. Lisa
and Brewer, C. LaPrincess",
title="Improvements in Diet and Physical Activity--Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="12",
volume="9",
number="11",
pages="e28024",
keywords="African Americans",
keywords="cardiovascular health disparities",
keywords="mHealth lifestyle intervention",
keywords="diet",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73\% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory--informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=?0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. ",
doi="10.2196/28024",
url="https://mhealth.jmir.org/2021/11/e28024",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766917"
}


@Article{info:doi/10.2196/30622,
author="Carey, Alissa
and Yang, Qiuchen
and DeLuca, Laura
and Toro-Ramos, Tatiana
and Kim, Youngin
and Michaelides, Andreas",
title="The Relationship Between Weight Loss Outcomes and Engagement in a Mobile Behavioral Change Intervention: Retrospective Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="8",
volume="9",
number="11",
pages="e30622",
keywords="engagement",
keywords="mHealth",
keywords="obesity",
keywords="weight management",
keywords="Noom",
keywords="application",
keywords="app",
keywords="behavioral change",
keywords="digital behavior change interventions",
abstract="Background: There is large variance in weight loss outcomes of digital behavior change interventions (DBCIs). It has been suggested that different patterns of engagement in the program could be responsible for this variance in outcomes. Previous studies have found that the amount of engagement on DBCIs, such as the number of meals logged or articles read, is positively associated with weight loss. Objective: This retrospective study extends previous research by observing how important weight loss outcomes (high weight loss: 10\% or greater body weight loss; moderate weight loss: between 5\% to 10\%; stable weight: 0 plus or minus 1\%) are associated with engagement on a publicly available mobile DBCI (Noom) from 9 to 52 weeks. Methods: Engagement and weight data for eligible participants (N=11,252) were extracted from the Noom database. Engagement measures included the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week. Weight was self-reported on the program. Multiple linear regressions examined how weight loss outcome (moderate and high vs stable) was associated with each engagement measure across 3 study time periods: 9-16 weeks, 17-32 weeks, and 33-52 weeks. Results: At 9-16 weeks, among the 11,252 participants, 2594 (23.05\%) had stable weight, 6440 (57.23\%) had moderate weight loss, and 2218 (19.71\%) had high weight loss. By 33-52 weeks, 525 (18.21\%) had stable weight, 1214 (42.11\%) had moderate weight loss, and 1144 (39.68\%) had high weight loss. Regression results showed that moderate weight loss and high weight loss outcomes were associated with all engagement measures to a significantly greater degree than was stable weight (all P values <.001). These differences held across all time periods with the exception of exercise for the moderate weight loss category at 1 time period of 33-52 weeks. Exercise logging increased from 9 to 52 weeks regardless of the weight loss group. Conclusions: Our results suggest that these clinically important weight loss outcomes are related to the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week both in the short-term and long-term (ie, 1 year) on Noom. This provides valuable data on engagement patterns over time on a self-directed mobile DBCI, can help inform how interventions tailor recommendations for engagement depending on how much weight individuals have lost, and raises important questions for future research on engagement in DBCIs. ",
doi="10.2196/30622",
url="https://mhealth.jmir.org/2021/11/e30622",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747706"
}


@Article{info:doi/10.2196/28689,
author="Bragg, Marie
and Lutfeali, Samina
and Greene, Tenay
and Osterman, Jessica
and Dalton, Madeline",
title="How Food Marketing on Instagram Shapes Adolescents' Food Preferences: Online Randomized Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="22",
volume="23",
number="10",
pages="e28689",
keywords="food marketing",
keywords="traditional media",
keywords="social media",
keywords="adolescents",
keywords="Instagram",
abstract="Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children's exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents' preferences. Objective: This study examined whether adolescents could identify food companies' Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents' preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame---which includes the logo, comments, and ``likes.'' In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the ``labeled ad condition.'' In the ``unlabeled ad condition,'' however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features. ",
doi="10.2196/28689",
url="https://www.jmir.org/2021/10/e28689",
url="http://www.ncbi.nlm.nih.gov/pubmed/34677136"
}


@Article{info:doi/10.2196/32298,
author="Shea, Benjamin
and Bakre, Shivani
and Carano, Keaton
and Scharen, Jared
and Langheier, Jason
and Hu, A. Emily",
title="Changes in Glycemic Control Among Individuals With Diabetes Who Used a Personalized Digital Nutrition Platform: Longitudinal Study",
journal="JMIR Diabetes",
year="2021",
month="Oct",
day="18",
volume="6",
number="4",
pages="e32298",
keywords="diabetes",
keywords="hyperglycemia",
keywords="hemoglobin A1c",
keywords="HbA1c",
keywords="blood glucose",
keywords="digital health",
keywords="nutrition",
keywords="meal planning",
keywords="food environment",
keywords="food ordering",
keywords="food purchasing",
keywords="platform",
keywords="longitudinal",
keywords="characteristic",
keywords="diet",
keywords="education",
abstract="Background: Diabetes-related costs are the highest across all chronic conditions in the United States, with type 2 diabetes accounting for up to 95\% of all cases of diabetes. A healthy diet is strongly associated with lowering glycated hemoglobin A1c (HbA1c) levels among individuals with diabetes, which can help curtail other health complications. Digital health platforms can offer critical support for improving diet and glycemic control among individuals with diabetes. Less is known about the characteristics of people with diabetes who use digital health platforms (specifically, a platform that integrates personalized healthy meal plans and food ordering) and changes in their HbA1c levels. Objective: The aim of this study is to characterize Foodsmart users with diabetes and evaluate the longitudinal impact of Foodsmart---a personalized digital nutrition platform with meal planning, food ordering, and nutrition education features---on changes in HbA1c levels. Methods: We retrospectively analyzed data collected from 643 adults with at least two self-reported HbA1c entries in the Foodsmart platform between January 2016 and June 2021. Participants self-reported their HbA1c levels, height, weight, health conditions, and diet in a 53-item food frequency questionnaire. Diabetes was defined as HbA1c ?6.5\%. We analyzed distributions of characteristics by baseline diabetes status and examined the association of characteristics with the likelihood of having diabetes at baseline. To evaluate the change in HbA1c levels among Foodsmart users, we calculated mean changes (absolute and percent) in HbA1c among participants with diabetes and by length of follow-up. We also compared changes in HbA1c and weight between participants with diabetes at baseline who achieved a normal HbA1c level and those who did not. Results: We found that 43.5\% (280/643) of the participants with at least two HbA1c level entries had diabetes at baseline. Participants with diabetes at baseline were more likely to be male, have a higher weight and BMI, report high blood pressure, and have a poorer diet in comparison to participants without diabetes. Using a multivariable logistic regression model, we found that being male and obese were statistically significantly associated with baseline diabetes. Among participants with diabetes at baseline, HbA1c was reduced, on average, by 0.46\%. In addition, 21.4\% (60/280) of participants with diabetes achieved a normal HbA1c level (<6.5\%) in their last HbA1c level entry; this percentage increased with longer follow-up time (39\% [7/18] at >24 months). In a sensitivity analysis, users with an HbA1c ?7.0\% at baseline had an average absolute change of --0.62\% and 31.2\% (62/199) of these participants achieved HbA1c levels of less than 7.0\%. Conclusions: This study assessed characteristics of individuals enrolled on the Foodsmart platform with HbA1c levels and found that users with diabetes had lower HbA1c levels over time and a sizable percentage of participants were successful in achieving normal levels. ",
doi="10.2196/32298",
url="https://diabetes.jmir.org/2021/4/e32298",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661545"
}


@Article{info:doi/10.2196/27153,
author="Feldhege, Johannes
and Moessner, Markus
and Bauer, Stephanie",
title="Detrimental Effects of Online Pro--Eating Disorder Communities on Weight Loss and Desired Weight: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="6",
volume="23",
number="10",
pages="e27153",
keywords="pro-eating disorder communities",
keywords="weight loss",
keywords="body weight",
keywords="social media",
keywords="linear growth models",
keywords="eating disorders",
keywords="pro-ED",
keywords="Reddit",
abstract="Background: Online pro--eating disorder (pro-ED) communities are considered harmful because of their detrimental effects on their users' body dissatisfaction, dieting, and help seeking. To date, it is unknown to which extent participation in pro-ED communities affects users' body weight and desired weight loss. Objective: This study aims to investigate the changes in the current and desired body weight of users of a pro-ED community (r/proed) on the social media website Reddit over time. Methods: Data on 1170 users and the unsolicited weight information they shared with the pro-ED community were collected over a period of 15 months. Linear growth models were used to model changes in the users' current and desired BMI over time. Results: Both current and desired BMI decreased over time, with a predicted rate of 0.087 and 0.015 BMI points per week, respectively. Weight loss was moderated by the users' activity level in the community, with more active users losing more weight. Users with a higher baseline BMI experienced greater weight loss, but even users with a very low baseline weight (BMI <17 kg/m2) lost weight during their participation. In addition, users decreased their desired weight over time, with many pursuing extremely low, unrealistic weight goals. Changes in the desired weight were moderated by the baseline current BMI and baseline desired BMI. Users with higher desired weight and lower body weight at baseline decreased their desired weight more over time. Conclusions: This is the first study to demonstrate the detrimental effects of pro-ED communities in a longitudinal study based on a large data set of user-generated online data. The results extend the literature detailing the harmful effects of online pro-ED communities by showing users' weight loss, decreases in desired weight, and that higher activity levels lead to greater weight loss. Users could be driven to pursue very low, unrealistic weight loss goals by images of very thin bodies presented in these communities. ",
doi="10.2196/27153",
url="https://www.jmir.org/2021/10/e27153",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612830"
}


@Article{info:doi/10.2196/17811,
author="Mayoh, Joanne
and Jones, Ian",
title="Young People's Experiences of Engaging With Fitspiration on Instagram: Gendered Perspective",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="4",
volume="23",
number="10",
pages="e17811",
keywords="social media",
keywords="gender",
keywords="physical fitness",
keywords="women's health",
keywords="men's health",
keywords="body ideals",
abstract="Background: Fitness inspiration or fitspiration is a term used to describe web-based images of fit people, people in the gym, health foods, or inspirational quotes relating to diet and fitness being shared and consumed via visual social media. The popularity of this content is most notable via the Instagram platform. Currently, the majority of fitspiration research has focused on women's experiences; however, increasingly, studies have pointed to the need to explore the gendered ways by which people engage with this content. Objective: The aim of this study is to explore how young men and women engage in fitspiration content on Instagram and provide a gendered analysis of how and why they consume this content. Methods: This study used a cross-sectional web-based survey (N=1213) of UK-based fitspiration users aged 18-24 years consisting of closed-ended questions to capture quantitative data. Results: The majority actively using Instagram for fitspiration (therefore eligible participants) were women (826/1175, 70.30\%). Men were more likely to view content posted by athletes ($\chi$21, N=1153=71.8; P=.001) and bodybuilders ($\chi$21, N=1153=32.8; P<.001), whereas women were more likely to view content related to weight loss ($\chi$21, N=1153=36.8; P<.001), diet plans ($\chi$21, N=1153=11.9; P<.001), and celebrities' content ($\chi$21, N=1153=33.5; P<.001). Men were more likely to use fitspiration as a source of inspiration to exercise to gain muscle or get stronger ($\chi$21, N=1147=17.9; P<.001), whereas women were more likely to use fitspiration as inspiration for healthy eating ($\chi$21, N=1147=37.7; P<.001), or to exercise to diet or lose weight ($\chi$21, N=1147=13.5; P<.001). Women were more likely to engage in passive behaviors such as viewing content on their feed ($\chi$21, N=1139=7.9; P=.005) or scrolling through accounts ($\chi$21, N=1139=15.2; P<.001), whereas men were more likely to engage in active consumption by tagging fitspiration accounts in posts ($\chi$21, N=1139=7.2; P=.007), commenting on posts ($\chi$21, N=1139=8.1; P=.004), and posting fitspiration content ($\chi$21, N=1139=6.4; P=.01). Conclusions: Female fitspiration consumers engaged with content that reinforced the feminine thin but shapely ideal, whereas male users sought out content that reinforced the masculine muscular ideal. Male users were more likely to engage actively with content (eg, posting fitspiration content), while female users were more likely to engage passively (eg, scrolling through accounts, posts, or images). Future research should consider how fitspiration consumption reflects and reproduces oppressive gender ideology. ",
doi="10.2196/17811",
url="https://www.jmir.org/2021/10/e17811",
url="http://www.ncbi.nlm.nih.gov/pubmed/34605768"
}


@Article{info:doi/10.2196/20520,
author="Chew, Elaine Chu Shan
and Davis, Courtney
and Lim, Ethel Jie Kai
and Lim, Micheal Chee Meng
and Tan, Henny Yi Zhen
and Oh, Yin Jean
and Rajasegaran, Kumudhini
and Chia, Michael Yong Hwa
and Finkelstein, Andrew Eric",
title="Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e20520",
keywords="pediatric obesity",
keywords="mobile health",
keywords="apps",
keywords="health behavior",
keywords="mHealth",
keywords="obesity",
keywords="adolescent",
keywords="lifestyle",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app--based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo's health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55\%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83\% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83\% (33/40) of participants completing at least 7 coaching sessions. In total, 78\% (18/23) of participants rated the app as good to excellent and 70\% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. ",
doi="10.2196/20520",
url="https://www.jmir.org/2021/9/e20520",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581672"
}


@Article{info:doi/10.2196/31621,
author="Tully, Louise
and Sorensen, Jan
and O'Malley, Grace",
title="Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="14",
volume="9",
number="9",
pages="e31621",
keywords="childhood obesity",
keywords="pediatric weight management",
keywords="economic evaluation",
keywords="digital health",
keywords="telemedicine",
keywords="mHealth",
abstract="Background: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at {\texteuro}142 (SD 23.7), whereas the cost per adolescent in the mHealth group was {\texteuro}722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was \$1={\texteuro}0.7525. The costs incurred for those who withdrew from the study ranged from {\texteuro}35 to {\texteuro}681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at {\texteuro}59,046 using the assessed approach. Conclusions: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855 ",
doi="10.2196/31621",
url="https://mhealth.jmir.org/2021/9/e31621",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519665"
}


@Article{info:doi/10.2196/24515,
author="Wartenberg, Lisa
and Raber, Margaret
and Chandra, Joya",
title="Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="13",
volume="23",
number="9",
pages="e24515",
keywords="pediatric oncology",
keywords="web-based resources",
keywords="oncology nutrition",
keywords="culinary education",
keywords="oncology",
keywords="children",
keywords="pediatric",
keywords="nutrition",
keywords="culinary",
keywords="education",
abstract="Background: Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. Objective: We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. Methods: We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research's Healthy Recipes, The Children's Hospital of San Antonio's Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center's Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. Results: Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. Conclusions: The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience. ",
doi="10.2196/24515",
url="https://www.jmir.org/2021/9/e24515",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515643"
}


@Article{info:doi/10.2196/25751,
author="Summers, Charlotte
and Tobin, Simon
and Unwin, David",
title="Evaluation of the Low Carb Program Digital Intervention for the Self-Management of Type 2 Diabetes and Prediabetes in an NHS England General Practice: Single-Arm Prospective Study",
journal="JMIR Diabetes",
year="2021",
month="Sep",
day="9",
volume="6",
number="3",
pages="e25751",
keywords="Low Carb Program",
keywords="low carbohydrate",
keywords="diabetes",
keywords="type 2 diabetes intervention",
keywords="diabetes prevention",
keywords="self-management",
keywords="behavior change",
keywords="prediabetes",
abstract="Background: Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, and stroke. Researchers and clinicians are increasingly in agreement that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. Digital apps are increasingly used as an adjunct to traditional health care provisions to support remote self-management of long-term health conditions. Objective: Our objective was to evaluate the real-world 12-month outcomes of patients prescribed the Low Carb Program digital health intervention at a primary care National Health Service (NHS) site. The Low Carb Program is a nutritionally focused, 12-session, digitally delivered, educational behavior change intervention for glycemic control and weight loss for adults with prediabetes and type 2 diabetes. The program educates and supports sustainable dietary changes focused on carbohydrate restriction by utilizing behavior change techniques, including goal setting, peer support, and behavioral self-monitoring, as well as personalized downloadable resources, including recipes and meal plans tailored to ethnicity, weekly shopping budget, and dietary preferences. Methods: This study evaluated the real-world outcomes of patients recruited to the Low Carb Program at an NHS general practice in Southport, United Kingdom. All of the NHS patients recruited to the program were diagnosed with type 2 diabetes or prediabetes and were given access to the program at no cost. A total of 45 participants, with a mean age of 54.8 years (SD 13.2), were included in the study. Women made up 42\% (19/45) of the sample. The mean hemoglobin A1c (HbA1c) of the sample was 56.7 mmol/mol (SD 16.95) and the mean body weight was 89.4 kg (SD 13.8). Results: Of the 45 study participants recruited to the program, all of them (100\%) activated their accounts and 37 (82\%) individuals reported outcomes at 12 months. All 45 (100\%) patients completed at least 40\% of the lessons and 32 (71\%) individuals completed more than nine out of 12 core lessons of the program. Glycemic control and weight loss improved, particularly for participants who completed more than nine core lessons in the program over 12 months. The mean HbA1c went from 58.8 mmol/mol at baseline to 54.0 mmol/mol, representing a mean reduction of 4.78 mmol/mol (SD 4.60; t31=5.87; P<.001). Results showed an average total body weight reduction of 4.17\%, with an average weight reduction of 3.85 kg (SD 2.49; t31=9.27; P<.001) at the 12-month follow-up point. Conclusions: A digital app prescribed to adults with type 2 diabetes and prediabetes in a primary care setting supporting a transition to a low-carbohydrate diet has been shown to be effective in improving glycemic control and enabling weight loss. Further research to understand more about factors affecting engagement with the app and further positive health implications would be valuable. ",
doi="10.2196/25751",
url="https://diabetes.jmir.org/2021/3/e25751",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499035"
}


@Article{info:doi/10.2196/26054,
author="Wyse, Rebecca
and Delaney, Tessa
and Stacey, Fiona
and Zoetemeyer, Rachel
and Lecathelinais, Christophe
and Lamont, Hannah
and Ball, Kylie
and Campbell, Karen
and Rissel, Chris
and Attia, John
and Wiggers, John
and Yoong, Lin Sze
and Oldmeadow, Christopher
and Sutherland, Rachel
and Nathan, Nicole
and Reilly, Kathryn
and Wolfenden, Luke",
title="Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Web-Based Canteen Lunch Orders (Click \& Crunch): Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="7",
volume="23",
number="9",
pages="e26054",
keywords="nudge",
keywords="choice architecture",
keywords="intervention",
keywords="online canteen",
keywords="online ordering systems",
keywords="digital interventions",
keywords="school children",
keywords="school food service",
keywords="canteens",
keywords="menu labeling",
abstract="Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-030538 ",
doi="10.2196/26054",
url="https://www.jmir.org/2021/9/e26054",
url="http://www.ncbi.nlm.nih.gov/pubmed/34491207"
}


@Article{info:doi/10.2196/23050,
author="Folkvord, Frans
and Haga, Gosse
and Theben, Alexandra",
title="The Effect of a Serious Health Game on Children's Eating Behavior: Cluster-Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Sep",
day="2",
volume="9",
number="3",
pages="e23050",
keywords="children",
keywords="eating behavior",
keywords="food-cues",
keywords="serious health game",
keywords="health intervention",
abstract="Background: Currently, children's dietary intake patterns do not meet prescribed dietary guidelines. Consequently, childhood obesity is one of the most serious health concerns. Therefore, innovative methods need to be developed and tested in order to effectively improve the dietary intake of children. Teaching children how to cope with the overwhelming number of unhealthy food cues could be conducted effectively by serious health games. Objective: The main aim of this study was to examine the effect of a serious health computer game on young children's eating behavior and attitudes toward healthy and unhealthy foods. Methods: A cluster-randomized controlled trial with a between-group design was conducted (n=157; 8-12 years), wherein children played a game that promoted a healthy lifestyle or attended regular classes and did not play a game (control). The game was designed in collaboration with researchers and pilot-tested among a group of children repeatedly before conducting the experiment. After 1 week of playing, attitudes toward food snacks and actual intake (children could eat ad libitum from fruits or energy-dense snacks) was assessed. Results: The results showed that playing a serious health game did not have an effect on attitude toward fruits or energy-dense snacks or on the intake of fruits or less energy-dense snacks. Additional Bayesian analyses supported these findings. Conclusions: Serious health games are increasingly considered to be a potential effective intervention when it comes to behavior change. The results of the current study stress the importance of tailoring serious health games in order to be effective, because no effect was found on attitude or eating behavior. Trial Registration: ClinicalTrials.gov NCT05025995; https://tinyurl.com/mdd7wrjd ",
doi="10.2196/23050",
url="https://games.jmir.org/2021/3/e23050",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473061"
}


@Article{info:doi/10.2196/27454,
author="Coleone, Diomara Joane
and Bellei, Andrei Ericles
and Roman, Klein Mateus
and Kirsten, Ramos Vanessa
and De Marchi, Bertoletti Ana Carolina",
title="Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="27",
volume="5",
number="8",
pages="e27454",
keywords="eating",
keywords="mobile applications",
keywords="primary health care",
keywords="aged",
keywords="type 2 diabetes mellitus",
abstract="Background: Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective: In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods: First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants' demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5\% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results: Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1\%), fruits (76.6\%), milk products (68.2\%), fried foods (72.7\%), savory biscuits (60.4\%), cookies or sweets (72.1\%), and sugary drinks (92.9\%) Meanwhile, the consumption of beans (59.7\%), pulses and cooked vegetables (73.4\%), and processed meat products (59.7\%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions: We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings. ",
doi="10.2196/27454",
url="https://formative.jmir.org/2021/8/e27454",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448711"
}


@Article{info:doi/10.2196/19917,
author="Hornsby, B.
and Ensaff, H.",
title="Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="19",
volume="23",
number="8",
pages="e19917",
keywords="medical news",
keywords="online news",
keywords="user comments",
keywords="public health",
keywords="population health",
keywords="qualitative analysis",
keywords="perspectives",
keywords="dietary guidelines",
keywords="diet",
keywords="fruit and vegetable consumption",
keywords="mobile phone",
abstract="Background: News websites are an essential source of medical news for the public. Many websites offer users the opportunity to leave comments, which may provide rich insights into public perspectives on health issues. With an established role in public health, fruit and vegetable (FV) consumption is central to the government's dietary guidelines. However, FV intake continues to fall short of government recommendations. Objective: Using comments from news websites, this study aims to explore public perspectives on FV intake and related government dietary guidelines. Methods: Data comprised 2696 web user comments generated in response to substantial media coverage for a meta-analysis examining FV consumption and the risk of all-cause mortality, cardiovascular disease, and total cancer. Using an inductive thematic approach, the data were analyzed and coded in an iterative process. Results: Four overarching themes emerged: personal factors, rejection, lack of knowledge, and food landscape, each with component subthemes. The lack of clarity around government dietary health guidelines was apparent, and this, along with emergent personal factors, may hinder better consumption. Rejection was also evident, as was a quality versus quantity of life debate. Conclusions: There are gaps in the public's understanding of government guidelines, which may act as a constraint to better compliance. Further work should examine this issue and rejection and the possibility of public fatigue related to dietary health information and news. Similarly, future work should also explore targeted interventions with a specific emphasis on health literacy. ",
doi="10.2196/19917",
url="https://www.jmir.org/2021/8/e19917",
url="http://www.ncbi.nlm.nih.gov/pubmed/34420913"
}


@Article{info:doi/10.2196/24523,
author="Mohd Hanim, Faiz Muhammad
and Md Sabri, Aslinie Budi
and Yusof, Norashikin",
title="Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Aug",
day="18",
volume="7",
number="8",
pages="e24523",
keywords="sugar-sweetened beverages",
keywords="obesity",
keywords="taxes",
keywords="media content analysis",
keywords="public health policy",
keywords="media content",
keywords="public health",
keywords="netnography",
keywords="malaysia",
keywords="budget",
abstract="Background: In Malaysia, the Sugar-Sweetened Beverages (SSBs) tax was announced during the parliament's 2019 Budget Speech. The tax was slated to be enforced by April 2019 but was later postponed to July 2019. The announcement has since generated significant media coverage and public feedback. Objective: This study presents a qualitative and quantitative cross-sectional study using netnography to examine how Malaysian online news articles responded to the SSBs tax after the announcement and postimplementation. Methods: Online news articles published on popular online news platforms from November 2018 to August 2019 were downloaded using NCapture and imported into NVivo for analysis using the inductive approach and thematic content analysis following the initial SSBs implementation announcement. Results: A total of 62 news articles were analyzed. Most of the articles positively portrayed the SSBs tax (46.8\%) and highlighted its health impacts (76\%). There were 7 key framing arguments identified in the articles. The positive arguments revolved around incentivizing manufacturers to introduce healthier products voluntarily, positive health consequences, the tax's impact on government revenue, and the use of the generated revenue toward beneficial social programs. The opposing arguments included increased operating costs to the manufacturer, the increased retail price of drinks, and how the SSBs tax is not a robust solution to obesity. The top priority sector considered in introducing the tax was the health perspective, followed by economic purposes and creating policies such as regulating the food and drinks industry. Conclusions: The majority of online news articles positively reported the implementation of the SSBs tax in Malaysia. This suggests media played a role in garnering support for the health policy. As such, relevant bodies can use negative findings to anticipate and reframe counteracting arguments opposing the SSBs tax. ",
doi="10.2196/24523",
url="https://publichealth.jmir.org/2021/8/e24523",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406125"
}


@Article{info:doi/10.2196/28930,
author="Richardson, Marie Kelli
and Cota Aguirre, Gloria
and Weiss, Rick
and Cinar, Ali
and Liao, Yue
and Marano, Kari
and Bedoya, R. Arianna
and Schembre, Susan",
title="Abbreviated Dietary Self-monitoring for Type 2 Diabetes Management: Mixed Methods Feasibility Study",
journal="JMIR Diabetes",
year="2021",
month="Aug",
day="12",
volume="6",
number="3",
pages="e28930",
keywords="diabetes mellitus, type 2",
keywords="diet, diabetic",
keywords="feasibility studies",
keywords="diet records",
keywords="dietary carbohydrates",
abstract="Background: Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Diabetes Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. Although current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic stability among people with T2D, tracking all intake is burdensome and unsustainable. Thus, dietary self-monitoring approaches that are equally effective but are less burdensome should be explored. Objective: This study aims to examine the feasibility of an abbreviated dietary self-monitoring approach in patients with T2D, in which only carbohydrate-containing foods are recorded in a diet tracker. Methods: We used a mixed methods approach to quantitatively and qualitatively assess general and diet-related diabetes knowledge and the acceptability of reporting only carbohydrate-containing foods in 30 men and women with T2D. Results: The mean Diabetes Knowledge Test score was 83.9\% (SD 14.2\%). Only 20\% (6/30) of participants correctly categorized 5 commonly consumed carbohydrate-containing foods and 5 noncarbohydrate-containing foods. The mean perceived difficulty of reporting only carbohydrate-containing foods was 5.3 on a 10-point scale. Approximately half of the participants (16/30, 53\%) preferred to record all foods. A lack of knowledge about carbohydrate-containing foods was the primary cited barrier to acceptability (12/30, 40\%). Conclusions: Abbreviated dietary self-monitoring in which only carbohydrate-containing foods are reported is likely not feasible because of limited carbohydrate-specific knowledge and a preference of most participants to report all foods. Other approaches to reduce the burden of dietary self-monitoring for people with T2D that do not rely on food-specific knowledge could be more feasible. ",
doi="10.2196/28930",
url="https://diabetes.jmir.org/2021/3/e28930",
url="http://www.ncbi.nlm.nih.gov/pubmed/34387551"
}


@Article{info:doi/10.2196/27452,
author="Rogers, C. Courtney
and Moutinho Jr, J. Thomas
and Liu, Xiaoyue
and Valdez, S. Rupa",
title="Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work",
journal="JMIR Hum Factors",
year="2021",
month="Aug",
day="10",
volume="8",
number="3",
pages="e27452",
keywords="Crohn disease",
keywords="inflammatory bowel diseases",
keywords="chronic disease",
keywords="self-management",
keywords="consumer health information technology",
keywords="qualitative research",
keywords="user-centered design",
keywords="patient work",
keywords="context",
keywords="articulation work",
keywords="diet",
keywords="nutrition",
abstract="Background: Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. Objective: The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. Methods: We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. Results: Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. Conclusions: This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time. ",
doi="10.2196/27452",
url="https://humanfactors.jmir.org/2021/3/e27452",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383664"
}


@Article{info:doi/10.2196/27885,
author="Vasiloglou, F. Maria
and Christodoulidis, Stergios
and Reber, Emilie
and Stathopoulou, Thomai
and Lu, Ya
and Stanga, Zeno
and Mougiakakou, Stavroula",
title="Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="30",
volume="9",
number="7",
pages="e27885",
keywords="dietary assessment",
keywords="end-users",
keywords="mHealth",
keywords="mobile apps",
keywords="smartphone",
keywords="survey",
keywords="apps",
keywords="nutrition",
keywords="diet",
keywords="mobile health",
keywords="users",
keywords="behavior",
keywords="behavior change",
abstract="Background: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results: A total of 2382 respondents (1891 female, 79.4\%; 474 male, 19.9\%; and 17 neither, 0.7\%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5\%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9\%), free cost (1413/2382, 59.3\%), and ability to produce automatic readings of caloric content (1231/2382, 51.7\%) and macronutrient content (1117/2382, 46.9\%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5\%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5\%) or that may omit major foods (977/2382, 41\%). Conclusions: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition. ",
doi="10.2196/27885",
url="https://mhealth.jmir.org/2021/7/e27885",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328425"
}


@Article{info:doi/10.2196/30450,
author="Weber, J. Summer
and Shearer, Elyse
and Mulvaney, A. Shelagh
and Schmidt, Douglas
and Thompson, Chris
and Jones, Jessica
and Ahmad, Haseeb
and Coe, Martina
and Hull, C. Pamela",
title="Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="30",
volume="5",
number="7",
pages="e30450",
keywords="WIC",
keywords="mobile technology",
keywords="maternal-child health",
keywords="childhood obesity",
keywords="nutrition",
keywords="government programs",
keywords="mobile app",
keywords="user-centered design",
keywords="low income",
keywords="women",
keywords="infant",
keywords="child",
keywords="formative",
keywords="development",
abstract="Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. ",
doi="10.2196/30450",
url="https://formative.jmir.org/2021/7/e30450",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328432"
}


@Article{info:doi/10.2196/29858,
author="Lim, Crystal
and Rutledge, Laura
and Sandridge, Shanda
and King, Krista
and Jefferson, Darryl
and Tucker, Tanya",
title="Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="28",
volume="10",
number="7",
pages="e29858",
keywords="digital health",
keywords="eHealth",
keywords="obesity",
keywords="pediatric obesity",
keywords="pediatrics",
keywords="remote patient monitoring",
keywords="telemedicine",
keywords="weight management",
abstract="Background: Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective: This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. Methods: Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. Results: We hypothesize high feasibility and satisfaction, with rates over 75\%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. Conclusions: This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. Trial Registration: ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597 International Registered Report Identifier (IRRID): DERR1-10.2196/29858 ",
doi="10.2196/29858",
url="https://www.researchprotocols.org/2021/7/e29858",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319245"
}


@Article{info:doi/10.2196/17780,
author="Mottas, Antoine
and Lappi, Veli-Matti
and Sundstr{\"o}m, Johan
and Neal, Bruce
and Mhurchu, Ni Cliona
and L{\"o}f, Marie
and R{\aa}dholm, Karin",
title="Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="22",
volume="9",
number="7",
pages="e17780",
keywords="breakfast cereals",
keywords="child-targeted cereals",
keywords="front-of-pack labels",
keywords="Keyhole symbol",
keywords="Health Star Rating",
keywords="FoodSwitch",
keywords="diet",
keywords="food intake",
abstract="Background: Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly. Objective: Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating. Methods: The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package. Results: Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8\% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P<.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P<.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P<.001). Total fat (3 g/100 g vs 10.5 g/100 g, P<.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P<.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5\% vs n=53, 22\%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating. Conclusions: Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals. ",
doi="10.2196/17780",
url="https://mhealth.jmir.org/2021/7/e17780",
url="http://www.ncbi.nlm.nih.gov/pubmed/34292165"
}


@Article{info:doi/10.2196/27448,
author="Grantham, L. Jordyn
and Verishagen, L. Carrie
and Whiting, J. Susan
and Henry, J. Carol
and Lieffers, L. Jessica R.",
title="Evaluation of a Social Media Campaign in Saskatchewan to Promote Healthy Eating During the COVID-19 Pandemic: Social Media Analysis and Qualitative Interview Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="21",
volume="23",
number="7",
pages="e27448",
keywords="COVID-19",
keywords="diet, healthy",
keywords="nutrition",
keywords="health promotion",
keywords="social media",
keywords="dietitian",
keywords="Saskatchewan",
abstract="Background: The beginning of the COVID-19 pandemic presented many sudden challenges regarding food, including grocery shopping changes (eg, reduced store hours, capacity restrictions, and empty store shelves due to food hoarding), restaurant closures, the need to cook more at home, and closures of food access programs. Eat Well Saskatchewan (EWS) implemented a 16-week social media campaign, \#eatwellcovid19, led by a dietitian and nutrition student that focused on sharing stories submitted by the Saskatchewan public about how they were eating healthy during the COVID-19 pandemic. Objective: The goal of this study was to describe the implementation of the \#eatwellcovid19 social media campaign and the results from the evaluation of the campaign, which included campaign performance using social media metrics and experiences and perspectives of campaign followers. Methods: Residents of Saskatchewan, Canada, were invited to submit personal stories and experiences to EWS about how they were eating healthy during the COVID-19 pandemic from April to August 2020. Each week, one to three stories were featured on EWS social media platforms---Facebook, Instagram, and Twitter---along with evidence-based nutrition information to help residents become more resilient to challenges related to food and nutrition experienced during the COVID-19 pandemic. Individuals who submitted stories were entered into a weekly draw for a Can \$100 grocery gift card. Social media metrics and semistructured qualitative interviews of campaign followers were used to evaluate the \#eatwellcovid19 campaign. Results: In total, 75 stories were submitted by 74 individuals on a variety of topics (eg, grocery shopping, traditional skills, and gardening), and 42 stories were featured on social media. EWS shared 194 \#eatwellcovid19 posts across social media platforms (Facebook: n=100; Instagram: n=55; and Twitter: n=39). On Facebook, \#eatawellcovid19 reached 100,571 followers and left 128,818 impressions, resulting in 9575 engagements. On Instagram, the campaign reached 11,310 followers, made 14,145 impressions, and received 823 likes and 15 comments. On Twitter, \#eatwellcovid19 made 15,199 impressions and received 424 engagements. Featured story submission posts had the best engagement on Facebook and the most likes and comments on Instagram. The EWS social media pages reported increases in their following during the campaign (Instagram: +30\%; Facebook: +14\%; and Twitter: +12\%). Results from the interviews revealed that there were two types of campaign followers: those who appreciated hearing the stories submitted by followers, as it helped them to feel connected to the community during social isolation, and those who appreciated the evidence-based information. Conclusions: Numerous stories were submitted to the \#eatwellcovid19 social media campaign on various topics. On Instagram and Facebook, posts that featured these stories had the highest engagement. During this campaign, EWS's social media following increased by more than 10\% on each platform. The approach used for the \#eatwellcovid19 campaign could be considered by others looking to develop health promotion campaigns. ",
doi="10.2196/27448",
url="https://www.jmir.org/2021/7/e27448",
url="http://www.ncbi.nlm.nih.gov/pubmed/34133314"
}


@Article{info:doi/10.2196/22968,
author="Alshehri, Fayz
and Alshaikh, Fahdah",
title="Exploring the Constituent Elements of a Successful Mobile Health Intervention for Prediabetic Patients in King Saud University Medical City Hospitals in Saudi Arabia: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="20",
volume="5",
number="7",
pages="e22968",
keywords="prediabetes",
keywords="mHealth",
keywords="CeHRes roadmap",
keywords="Saudi Arabia",
abstract="Background: Self-management of prediabetic patients is crucial since they are at high risk of developing type 2 diabetes. Mobile health (mHealth) apps could contribute to potentially reducing the burden of diabetes by supporting the self-management of prediabetic patients. Objective: This study aimed to explore the constituent elements of a successful mHealth intervention for prediabetic patients in King Saud University Medical City (KSUMC) hospitals in Saudi Arabia using the Centre for eHealth Research (CeHRes) roadmap. Methods: This study used the CeHRes roadmap as a developmental guideline for proposing mHealth app features for self-management of prediabetic patients and was performed in 3 phases with one round in each phase. First, a contextual inquiry was conducted via an online self-administered questionnaire for both health care providers and patients. Second, the value specification phase elaborated on the outcomes from the contextual inquiry phase. Finally, prototype user design was performed in cocreation with end users. The design phase was also conducted via an online self-administered questionnaire to evaluate the proposed features of mHealth apps by prediabetic patients. Results: A total of 20 health care providers participated in the study. The results revealed that the most powerful intervention for prediabetes was a combination of medication, physical activity, and healthy diet plans (12/20, 60\%). Furthermore, the most common challenge faced by prediabetes patients was patient adherence to healthy diet and physical activity recommendations (10/20, 50\%). Almost all patients believed that mHealth apps would be useful for prediabetic patients. A total of 48 prediabetic patients participated in the study. The results indicated that the most powerful intervention for prediabetic patients is a combination of healthy diet and physical activity plans (21/48, 44\%), and the most frequent challenge that may lead the patients to discontinue the current intervention was the commitment to a physical activity plan (35/48, 75\%). Furthermore, 15\% (17/48) of patients use well-being and health apps to manage their current health status. The most common difficulties faced by the patients were navigating app features (mean 2.02 [SD 1.7]) followed by the app language (mean 1.88 [SD 2.0]); these difficulties occurred at a significantly higher rate among those with secondary or lower educational levels as compared to undergraduate and postgraduate levels (P<.05). Finally, the features proposed in the prototype design scored more than 2.5 points higher and indicate the need for these features to be included in the mHealth app. Conclusions: This study aimed to provide real-world insights into the development of an mHealth app for a diabetes prevention intervention by involving both health care providers and prediabetic patients in KSUMC hospitals. Therefore, the proposed app, which comprises all necessary features, may aid patients with prediabetes in self-management and making changes in their lifestyle. ",
doi="10.2196/22968",
url="https://formative.jmir.org/2021/7/e22968",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061762"
}


@Article{info:doi/10.2196/18741,
author="Farage, Gregory
and Simmons, Courtney
and Kocak, Mehmet
and Klesges, C. Robert
and Talcott, Wayne G.
and Richey, Phyllis
and Hare, Marion
and Johnson, C. Karen
and Sen, Saunak
and Krukowski, Rebecca",
title="Assessing the Contribution of Self-Monitoring Through a Commercial Weight Loss App: Mediation and Predictive Modeling Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="14",
volume="9",
number="7",
pages="e18741",
keywords="weight loss",
keywords="self-monitoring",
keywords="obesity",
keywords="apps",
keywords="behavioral intervention",
abstract="Background: Electronic self-monitoring technology has the potential to provide unique insights into important behaviors for inducing weight loss. Objective: The aim of this study is to investigate the effects of electronic self-monitoring behavior (using the commercial Lose It! app) and weight loss interventions (with differing amounts of counselor feedback and support) on 4- and 12-month weight loss. Methods: In this secondary analysis of the Fit Blue study, we compared the results of two interventions of a randomized controlled trial. Counselor-initiated participants received consistent support from the interventionists, and self-paced participants received assistance upon request. The participants (N=191), who were active duty military personnel, were encouraged to self-monitor their diet and exercise with the Lose It! app or website. We examined the associations between intervention assignment and self-monitoring behaviors. We conducted a mediation analysis of the intervention assignment for weight loss through multiple mediators---app use (calculated from the first principal component [PC] of electronically collected variables), number of weigh-ins, and 4-month weight change. We used linear regression to predict weight loss at 4 and 12 months, and the accuracy was measured using cross-validation. Results: On average, the counselor-initiated--treatment participants used the app more frequently than the self-paced--treatment participants. The first PC represented app use frequencies, the second represented calories recorded, and the third represented reported exercise frequency and exercise caloric expenditure. We found that 4-month weight loss was partially mediated through app use (ie, the first PC; 60.3\%) and the number of weigh-ins (55.8\%). However, the 12-month weight loss was almost fully mediated by 4-month weight loss (94.8\%). Linear regression using app data from the first 8 weeks, the number of self--weigh-ins at 8 weeks, and baseline data explained approximately 30\% of the variance in 4-month weight loss. App use frequency (first PC; P=.001), self-monitored caloric intake (second PC; P=.001), and the frequency of self-weighing at 8 weeks (P=.008) were important predictors of 4-month weight loss. Predictions for 12-month weight with the same variables produced an R2 value of 5\%; only the number of self--weigh-ins was a significant predictor of 12-month weight loss. The R2 value using 4-month weight loss as a predictor was 31\%. Self-reported exercise did not contribute to either model (4 months: P=.77; 12 months: P=.15). Conclusions: We found that app use and daily reported caloric intake had a substantial impact on weight loss prediction at 4 months. Our analysis did not find evidence of an association between participant self-monitoring exercise information and weight loss. As 12-month weight loss was completely mediated by 4-month weight loss, intervention targets should focus on promoting early and frequent dietary intake self-monitoring and self-weighing to promote early weight loss, which leads to long-term success. Trial Registration: ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178 ",
doi="10.2196/18741",
url="https://mhealth.jmir.org/2021/7/e18741",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259635"
}


@Article{info:doi/10.2196/13496,
author="Han, Myeunghee
and Rhee, Youl Sang",
title="Effect of Adherence to Smartphone App Use on the Long-term Effectiveness of Weight Loss in Developing and OECD Countries: Retrospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="12",
volume="9",
number="7",
pages="e13496",
keywords="low-income countries",
keywords="Organization for Economic Co-operation and Development",
keywords="body weight",
keywords="mobile app self-management",
keywords="diet",
keywords="exercise",
keywords="mobile phone",
abstract="Background: Globally, 71\% of deaths occur due to noncommunicable diseases (NCDs). Poor diet quality and physical activity have a significant impact on NCDs. At present, behavior change interventions using smartphone apps have rapidly increased worldwide to prevent NCDs. However, most previous studies on the use and effectiveness of apps have been conducted in Organization for Economic Co-operation and Development (OECD) countries. As such, relevant research in low-income countries is scarce. Objective: This retrospective cohort study aims to investigate the characteristics of adherence to the use of the Noom app. We also aim to compare the effects of using the app on body weight changes over time according to adherence to the use of the app between users in low-income and OECD countries. In addition, the differences in weight loss are compared among users who use the free and paid versions of the app. Methods: A secondary data analysis was conducted using repeated measures. The data were collected from users in low-income countries (n=312) and OECD countries (n=8041) who used the app for 12 months. The app provided programs for the self-monitoring of physical activity, dietary intake, and body weight. Descriptive statistics, independent two-tailed t tests, chi-square tests, and linear mixed models were used for the analysis. Results: During the first 3 months of using the Noom app, users from OECD countries entered data into the app more frequently; however, users in low-income countries entered data more frequently from 3 months to 12 months. Users in OECD countries consumed significantly more calories than those in low-income countries for 12 months. The body weight of all users significantly decreased over time (?1.8 kg; P<.001); however, no statistically significant differences in the change in body weight for 12 months were observed between users from low-income and OECD countries ($\beta$=?.2; P=.19). The users who frequently monitored their lunch ($\beta$=?.1; P<.001), dinner ($\beta$=?.1; P<.001), body weight ($\beta$=?.1; P<.001), evening snack ($\beta$=?.1; P<.001), and exercise ($\beta$=?.03; P<.001) exhibited significant weight loss over time. We found no significant differences in the body weight changes between users who used the free and paid versions of the app ($\beta$=?.2; P=.19). Conclusions: This study found that using the app has a significant effect on weight loss regardless of users' country of residence. The results of this study suggest that the frequency of monitoring health-related behaviors by entering data into the app plays a pivotal role in losing weight. In conclusion, regardless of where users live and what versions of the app they use, it is important to monitor health-related behaviors by frequently entering data into the app to efficiently lose weight. ",
doi="10.2196/13496",
url="https://mhealth.jmir.org/2021/7/e13496",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255708"
}


@Article{info:doi/10.2196/28144,
author="Kelly, Bridget
and Bosward, Rebecca
and Freeman, Becky",
title="Australian Children's Exposure to, and Engagement With, Web-Based Marketing of Food and Drink Brands: Cross-sectional Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="12",
volume="23",
number="7",
pages="e28144",
keywords="food",
keywords="beverage",
keywords="marketing",
keywords="online",
keywords="digital",
abstract="Background: Food is one of the most frequently promoted commodities, and promoted foods are overwhelmingly unhealthy. Marketing normalizes unhealthy foods, creates a positive brand image, and encourages overconsumption. Limited research is available to describe the extent of food marketing to children on web-based media, and measuring actual exposure is challenging. Objective: This study aims to monitor the extent of children's exposure to web-based media food marketing as an essential step in increasing the accountability of industry and governments to protect children. Methods: Children aged 13-17 years were recruited from October 2018 to March 2019. Children recorded their mobile device screen for 2 weekdays and 1 weekend day any time they visited relevant web-based platforms. After each day, the participants uploaded the video files to a secure server. Promoted products were defined using the World Health Organization European Region nutrient profile model. Results: The sample of 95 children uploaded 267.8 hours of video data. Children saw a median of 17.4 food promotions each hour on the internet. Considering the usual time spent on the internet on mobile devices, children would be exposed to a median of 168.4 food promotions on the web on mobile devices per week, 99.5 of which would not be permitted to be marketed based on nutrient profiling criteria. Most promotions (2613/4446, 58.77\%) were peer endorsed and derived from third-party sources. Conclusions: Exposure to brand content that is seemingly endorsed by peers or web-based communities likely heightens the effects of marketing on children. Regulations to protect children from this marketing must extend beyond paid advertising to paid content in posts generated through web-based communities and influencers. ",
doi="10.2196/28144",
url="https://www.jmir.org/2021/7/e28144",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255675"
}


@Article{info:doi/10.2196/28346,
author="Feldhege, Johannes
and Moessner, Markus
and Wolf, Markus
and Bauer, Stephanie",
title="Changes in Language Style and Topics in an Online Eating Disorder Community at the Beginning of the COVID-19 Pandemic: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="8",
volume="23",
number="7",
pages="e28346",
keywords="COVID-19",
keywords="eating disorders",
keywords="online eating disorder community",
keywords="language",
keywords="mental health",
keywords="social media",
keywords="LIWC",
keywords="Linguistic Inquiry and Word Count",
keywords="Reddit",
keywords="topic modeling",
abstract="Background: COVID-19 has affected individuals with lived experience of eating disorders (EDs), with many reporting higher psychological distress, higher prevalence of ED symptoms, and compensatory behaviors. The COVID-19 pandemic and the health and safety measures taken to contain its spread also disrupted routines and reduced access to familiar coping mechanisms, social support networks, and health care services. Social media and the ED communities on social media platforms have been an important source of support for individuals with EDs in the past. So far, it is unknown how discussions in online ED communities changed as offline support networks were disrupted and people spent more time at home in the first months of the COVID-19 pandemic. Objective: The aim of this study is to identify changes in language content and style in an online ED community during the initial onset of the COVID-19 pandemic. Methods: We extracted posts and their comments from the ED community on the social media website Reddit and concatenated them to comment threads. To analyze these threads, we applied top-down and bottom-up language analysis methods based on topic modeling with latent Dirichlet allocation and 13 indicators from the Linguistic Inquiry and Word Count program, respectively. Threads were split into prepandemic (before March 11, 2020) and midpandemic (after March 11, 2020) groups. Standardized mean differences were calculated to estimate change between pre- and midpandemic threads. Results: A total of 17,715 threads (n=8772, 49.5\% prepandemic threads; n=8943, 50.5\% midpandemic threads) were extracted from the ED community and analyzed. The final topic model contained 21 topics. CIs excluding zero were found for standardized mean differences of 15 topics and 9 Linguistic Inquiry and Word Count categories covering themes such as ED symptoms, mental health, treatment for EDs, cognitive processing, social life, and emotions. Conclusions: Although we observed a reduction in discussions about ED symptoms, an increase in mental health and treatment-related topics was observed at the same time. This points to a change in the focus of the ED community from promoting potentially harmful weight loss methods to bringing attention to mental health and treatments for EDs. These results together with heightened cognitive processing, increased social references, and reduced inhibition of negative emotions detected in discussions indicate a shift in the ED community toward a pro-recovery orientation. ",
doi="10.2196/28346",
url="https://www.jmir.org/2021/7/e28346",
url="http://www.ncbi.nlm.nih.gov/pubmed/34101612"
}


@Article{info:doi/10.2196/25850,
author="Ruf, Alea
and Koch, Doris Elena
and Ebner-Priemer, Ulrich
and Knopf, Monika
and Reif, Andreas
and Matura, Silke",
title="Studying Microtemporal, Within-Person Processes of Diet, Physical Activity, and Related Factors Using the APPetite-Mobile-App: Feasibility, Usability, and Validation Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="5",
volume="23",
number="7",
pages="e25850",
keywords="diet",
keywords="physical activity",
keywords="microtemporal processes",
keywords="within-person factors",
keywords="ecological momentary assessment",
keywords="smartphone-app",
keywords="mobile phone",
keywords="mHealth",
keywords="dietary assessment",
keywords="feasibility",
keywords="usability",
keywords="validity",
abstract="Background: Diet and physical activity (PA) have a major impact on physical and mental health. However, there is a lack of effective strategies for sustaining these health-protective behaviors. A shift to a microtemporal, within-person approach is needed to capture dynamic processes underlying eating behavior and PA, as they change rapidly across minutes or hours and differ among individuals. However, a tool that captures these microtemporal, within-person processes in daily life is currently not present.  Objective: The APPetite-mobile-app is developed for the ecological momentary assessment of microtemporal, within-person processes of complex dietary intake, objectively recorded PA, and related factors. This study aims to evaluate the feasibility and usability of the APPetite-mobile-app and the validity of the incorporated APPetite-food record.  Methods: The APPetite-mobile-app captures dietary intake event-contingently through a food record, captures PA continuously through accelerometers, and captures related factors (eg, stress) signal-contingently through 8 prompts per day. Empirical data on feasibility (n=157), usability (n=84), and validity (n=44) were collected within the Eat2beNICE-APPetite-study. Feasibility and usability were examined in healthy participants and psychiatric patients. The relative validity of the APPetite-food record was assessed with a subgroup of healthy participants by using a counterbalanced crossover design. The reference method was a 24-hour recall. In addition, the energy intake was compared with the total energy expenditure estimated from accelerometry.  Results: Good feasibility, with compliance rates above 80\% for prompts and the accelerometer, as well as reasonable average response and recording durations (prompt: 2.04 min; food record per day: 17.66 min) and latencies (prompts: 3.16 min; food record: 58.35 min) were found. Usability was rated as moderate, with a score of 61.9 of 100 on the System Usability Scale. The evaluation of validity identified large differences in energy and macronutrient intake between the two methods at the group and individual levels. The APPetite-food record captured higher dietary intakes, indicating a lower level of underreporting, compared with the 24-hour recall. Energy intake was assessed fairly accurately by the APPetite-food record at the group level on 2 of 3 days when compared with total energy expenditure. The comparison with mean total energy expenditure (2417.8 kcal, SD 410) showed that the 24-hour recall (1909.2 kcal, SD 478.8) underestimated habitual energy intake to a larger degree than the APPetite-food record (2146.4 kcal, SD 574.5).  Conclusions: The APPetite-mobile-app is a promising tool for capturing microtemporal, within-person processes of diet, PA, and related factors in real time or near real time and is, to the best of our knowledge, the first of its kind. First evidence supports the good feasibility and moderate usability of the APPetite-mobile-app and the validity of the APPetite-food record. Future findings in this context will build the foundation for the development of personalized lifestyle modification interventions, such as just-in-time adaptive interventions. ",
doi="10.2196/25850",
url="https://www.jmir.org/2021/7/e25850",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342268"
}


@Article{info:doi/10.2196/25327,
author="Benavides, Lynn Heidi
and Meireles, Lumachi Christiane
and Benavente, Viola
and Mays, Helen Mary
and Wang, Jing",
title="Decreasing COVID-19 Risk Factors for Older Adults by Using Digital Technology to Implement a Plant-Based-Diet: An Opinion",
journal="JMIR Aging",
year="2021",
month="Jul",
day="5",
volume="4",
number="3",
pages="e25327",
keywords="COVID-19",
keywords="coronavirus",
keywords="older adult",
keywords="plant-based diet",
keywords="eating patterns",
keywords="whole foods",
keywords="Mediterranean diet",
keywords="obesity",
keywords="pandemic",
keywords="ethnic minorities",
keywords="telehealth",
keywords="digital technology",
keywords="racial disparities",
keywords="aging",
doi="10.2196/25327",
url="https://aging.jmir.org/2021/3/e25327",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081595"
}


@Article{info:doi/10.2196/25529,
author="Vuorinen, Anna-Leena
and Helander, Elina
and Pietil{\"a}, Julia
and Korhonen, Ilkka",
title="Frequency of Self-Weighing and Weight Change: Cohort Study With 10,000 Smart Scale Users",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="28",
volume="23",
number="6",
pages="e25529",
keywords="self-monitoring",
keywords="self-weighing",
keywords="weight change, weight loss, normal weight, overweight, obese, temporal weight change",
abstract="Background: Frequent self-weighing is associated with successful weight loss and weight maintenance during and after weight loss interventions. Less is known about self-weighing behaviors and associated weight change in free-living settings. Objective: This study aimed to investigate the association between the frequency of self-weighing and changes in body weight in a large international cohort of smart scale users. Methods: This was an observational cohort study with 10,000 randomly selected smart scale users who had used the scale for at least 1 year. Longitudinal weight measurement data were analyzed. The association between the frequency of self-weighing and weight change over the follow-up was investigated among normal weight, overweight, and obese users using Pearson's correlation coefficient and linear models. The association between the frequency of self-weighing and temporal weight change was analyzed using linear mixed effects models. Results: The eligible sample consisted of 9768 participants (6515/9768, 66.7\% men; mean age 41.5 years; mean BMI 26.8 kg/m2). Of the participants, 4003 (4003/9768, 41.0\%), 3748 (3748/9768, 38.4\%), and 2017 (2017/9768, 20.6\%) were normal weight, overweight, and obese, respectively. During the mean follow-up time of 1085 days, the mean weight change was --0.59 kg, and the mean percentage of days with a self-weigh was 39.98\%, which equals 2.8 self-weighs per week. The percentage of self-weighing days correlated inversely with weight change, r=--0.111 (P<.001). Among normal weight, overweight, and obese individuals, the correlations were r=--0.100 (P<.001), r=--0.125 (P<.001), and r=--0.148 (P<.001), respectively. Of all participants, 72.5\% (7085/9768) had at least one period of ?30 days without weight measurements. During the break, weight increased, and weight gains were more pronounced among overweight and obese individuals: 0.58 kg in the normal weight group, 0.93 kg in the overweight group, and 1.37 kg in the obese group (P<.001). Conclusions: Frequent self-weighing was associated with favorable weight loss outcomes also in an uncontrolled, free-living setting, regardless of specific weight loss interventions. The beneficial associations of regular self-weighing were more pronounced for overweight or obese individuals. ",
doi="10.2196/25529",
url="https://www.jmir.org/2021/6/e25529",
url="http://www.ncbi.nlm.nih.gov/pubmed/34075879"
}


@Article{info:doi/10.2196/25256,
author="Sutherland, Rachel
and Brown, Alison
and Nathan, Nicole
and Yoong, Serene
and Janssen, Lisa
and Chooi, Amelia
and Hudson, Nayerra
and Wiggers, John
and Kerr, Nicola
and Evans, Nicole
and Gillham, Karen
and Oldmeadow, Christopher
and Searles, Andrew
and Reeves, Penny
and Davies, Marc
and Reilly, Kathryn
and Cohen, Brad
and Wolfenden, Luke",
title="A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness--Implementation Hybrid Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="24",
volume="23",
number="6",
pages="e25256",
keywords="childhood obesity",
keywords="lunchboxes",
keywords="children",
keywords="child nutrition",
keywords="mHealth",
keywords="schools",
keywords="hybrid",
keywords="randomized controlled trial",
keywords="technology",
abstract="Background: There is significant opportunity to improve the nutritional quality of foods packed in children's school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health--based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness--implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children's lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90\%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22\% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (--117.26 kJ; 95\% CI --195.59 to --39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (--88.38 kJ; 95\% CI --172.84 to --3.92; P=.04) and consumed (--117.17 kJ; 95\% CI --233.72 to --0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children's lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school--aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school--aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191\&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x ",
doi="10.2196/25256",
url="https://www.jmir.org/2021/6/e25256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185013"
}


@Article{info:doi/10.2196/25043,
author="van der Haar, Sandra
and Hoevenaars, M. Femke P.
and van den Brink, J. Willem
and van den Broek, Tim
and Timmer, Mari{\"e}lle
and Boorsma, Andr{\'e}
and Doets, L. Esm{\'e}e",
title="Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="24",
volume="5",
number="6",
pages="e25043",
keywords="personalized nutrition",
keywords="metabolic syndrome",
keywords="dietary behavior",
keywords="diet",
keywords="metabolic",
keywords="metabolic health",
keywords="dietary advice",
keywords="dietary feedback",
keywords="digital health",
abstract="Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 ",
doi="10.2196/25043",
url="https://formative.jmir.org/2021/6/e25043/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185002"
}


@Article{info:doi/10.2196/27807,
author="Beilharz, Francesca
and Sukunesan, Suku
and Rossell, L. Susan
and Kulkarni, Jayashri
and Sharp, Gemma",
title="Development of a Positive Body Image Chatbot (KIT) With Young People and Parents/Carers: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="16",
volume="23",
number="6",
pages="e27807",
keywords="body image",
keywords="eating disorder",
keywords="chatbot",
keywords="conversational agent",
keywords="artificial intelligence",
keywords="mental health",
keywords="digital health",
keywords="design",
abstract="Background: Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision. Objective: A world-first body image chatbot called ``KIT'' was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia's national eating disorder support organization, the Butterfly Foundation. Methods: A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat. Results: Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT's character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT's interactivity. Conclusions: Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT's efficacy. ",
doi="10.2196/27807",
url="https://www.jmir.org/2021/6/e27807",
url="http://www.ncbi.nlm.nih.gov/pubmed/34132644"
}


@Article{info:doi/10.2196/28392,
author="Hu, A. Emily
and Scharen, Jared
and Nguyen, Viet
and Langheier, Jason",
title="Evaluating the Impact of a Digital Nutrition Platform on Cholesterol Levels in Users With Dyslipidemia: Longitudinal Study",
journal="JMIR Cardio",
year="2021",
month="Jun",
day="10",
volume="5",
number="1",
pages="e28392",
keywords="dyslipidemia",
keywords="hyperlipidemia",
keywords="lipids",
keywords="cholesterol",
keywords="digital",
keywords="nutrition",
keywords="meal planning",
keywords="food environment",
keywords="food ordering",
keywords="food purchasing",
abstract="Background: A strong association exists between consuming a healthy diet and lowering cholesterol levels among individuals with high cholesterol. However, implementing and sustaining a healthy diet in the real world is a major challenge. Digital technologies are at the forefront of changing dietary behavior on a massive scale, as they can reach broad populations. There is a lack of evidence that has examined the benefit of a digital nutrition intervention, especially one that incorporates nutrition education, meal planning, and food ordering, on cholesterol levels among individuals with dyslipidemia. Objective: The aim of this observational longitudinal study was to examine the characteristics of people with dyslipidemia, determine how their status changed over time, and evaluate the changes in total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglycerides among individuals with elevated lipids who used Foodsmart, a digital nutrition platform that integrates education, meal planning, and food ordering. Methods: We included 653 adults who used Foodsmart between January 2015 and February 2021, and reported a lipid marker twice. Participants self-reported age, gender, weight, and usual dietary intake in a 53-item food frequency questionnaire, and lipid values could be provided at any time. Dyslipidemia was defined as total cholesterol ?200 mg/dL, HDL-C ?40 mg/dL, LDL-C ?130 mg/dL, or triglycerides ?150 mg/dL. We retrospectively analyzed distributions of user characteristics and their associations with the likelihood of returning to normal lipid levels. We calculated the mean changes and percent changes in lipid markers among users with elevated lipids. Results: In our total sample, 54.1\% (353/653) of participants had dyslipidemia at baseline. Participants with dyslipidemia at baseline were more likely to be older, be male, and have a higher weight and BMI compared with participants who had normal lipid levels. We found that 36.3\% (128/353) of participants who had dyslipidemia at baseline improved their lipid levels to normal by the end of follow-up. Using multivariate logistic regression, we found that baseline obesity (odds ratio [OR] 2.57, 95\% CI 1.25-5.29; P=.01) and Nutriscore (OR 1.04, 95\% CI 1.00-1.09; P=.04) were directly associated with achieving normal lipid levels. Participants with elevated lipid levels saw improvements as follows: HDL-C increased by 38.5\%, total cholesterol decreased by 6.8\%, cholesterol ratio decreased by 20.9\%, LDL-C decreased by 12.9\%, non-HDL-C decreased by 7.8\%, and triglycerides decreased by 10.8\%. Conclusions: This study characterized users of the Foodsmart platform who had dyslipidemia and found that users with elevated lipid levels showed improvements in the levels over time. ",
doi="10.2196/28392",
url="https://cardio.jmir.org/2021/1/e28392",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110291"
}


@Article{info:doi/10.2196/25794,
author="Chia, Airu
and Chew, Sheng Muhammad Naeem Jia
and Tan, Xuan Sarah Yi
and Chan, Jun Mei
and T Colega, Marjorelee
and Toh, Ying Jia
and Natarajan, Padmapriya
and Lan{\c{c}}a, Carla
and Shek, P. Lynette
and Saw, Seang-Mei
and M{\"u}ller-Riemenschneider, Falk
and Chong, Foong-Fong Mary",
title="A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL)",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="9",
volume="23",
number="6",
pages="e25794",
keywords="time use",
keywords="web-based",
keywords="diet",
keywords="movement behaviors",
keywords="usability",
keywords="schoolchildren",
abstract="Background: Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors. Objective: This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)---a self-administered, web-based time-use application to assess diet and movement behavior---and to evaluate its usability in schoolchildren in Singapore. Methods: MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire. Results: The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8\% boys, and 31/201, 15.4\% overweight) in the usability study, 57.8\% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1\%), that MEDAL was easy to use (173/203, 85.2\%), that they liked the application (172/202, 85.1\%), and that they preferred recording their activities on the web than on paper (167/202, 82.7\%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. Conclusions: MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress. ",
doi="10.2196/25794",
url="https://www.jmir.org/2021/6/e25794",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106084"
}


@Article{info:doi/10.2196/20981,
author="Hendrie, A. Gilly
and Baird, L. Danielle
and Brindal, Emily
and Williams, Gemma
and Brand-Miller, Jennie
and Muhlhausler, Beverly",
title="Weight Loss and Usage of an Online Commercial Weight Loss Program (the CSIRO Total Wellbeing Diet Online) Delivered in an Everyday Context: Five-Year Evaluation in a Community Cohort",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="7",
volume="23",
number="6",
pages="e20981",
keywords="obesity",
keywords="obesity management",
keywords="weight loss",
keywords="internet-based intervention",
abstract="Background: Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss. Objective: This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years. Methods: Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: ``stayers'' were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while ``starters'' began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss. Results: Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06\%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29\%) were classified as obese. At week 12, 94.56\% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48\% (24,756/59,686) at 24 weeks. At week 12, 52.03\% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59\% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1\% of their starting body weight. Stayers lost 4.9 kg (5.3\% of starting body weight) compared to starters, who lost 1.6 kg (1.7\% of starting body weight). Almost half (11,082/22,658, 48.91\%) the members who stayed on the program lost 5\% or more of their starting body weight, and 15.48\% (3507/22,658) achieved a weight loss of 10\% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39\% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24\% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss ($\beta$=.263; P<.001), with higher usage associated with greater weight loss. Conclusions: This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided. If the results demonstrated here can be achieved at an even greater scale, the potential social and economic benefits will be extremely significant. ",
doi="10.2196/20981",
url="https://www.jmir.org/2021/6/e20981",
url="http://www.ncbi.nlm.nih.gov/pubmed/34096869"
}


@Article{info:doi/10.2196/26421,
author="Andrade, Q. Andre
and Beleigoli, Alline
and Diniz, Fatima Maria De
and Ribeiro, Luiz Antonio",
title="Influence of Baseline User Characteristics and Early Use Patterns (24-Hour) on Long-Term Adherence and Effectiveness of a Web-Based Weight Loss Randomized Controlled Trial: Latent Profile Analysis",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="3",
volume="23",
number="6",
pages="e26421",
keywords="obesity",
keywords="overweight",
keywords="web platform",
keywords="digital health",
keywords="engagement",
keywords="latent profile analysis",
keywords="online interventions",
keywords="use data",
keywords="weight loss",
keywords="weight loss platform",
abstract="Background: Low adherence to real-world online weight loss interventions reduces long-term efficacy. Baseline characteristics and use patterns are determinants of long-term adherence, but we lack cohesive models to guide how to adapt interventions to users' needs. We also lack information whether very early use patterns (24 hours) help describe users and predict interventions they would benefit from. Objective: We aim to understand the impact of users' baseline characteristics and early (initial 24 hours) use patterns of a web platform for weight loss on user adherence and weight loss in the long term (24 weeks). Methods: We analyzed data from the POEmaS randomized controlled trial, a study that compared the effectiveness of a weight loss platform with or without coaching and a control approach. Data included baseline behavior and use logs from the initial 24 hours after platform access. Latent profile analysis (LPA) was used to identify classes, and Kruskal-Wallis was used to test whether class membership was associated with long-term (24 weeks) adherence and weight loss. Results: Among 828 participants assigned to intervention arms, 3 classes were identified through LPA: class 1 (better baseline health habits and high 24-hour platform use); class 2 (better than average health habits, but low 24-hour platform use); class 3 (worse baseline health habits and low 24-hour platform use). Class membership was associated with long-term adherence (P<.001), and class 3 members had the lowest adherence. Weight loss was not associated with class membership (P=.49), regardless of the intervention arm (platform only or platform + coach). However, class 2 users assigned to platform + coach lost more weight than those assigned to platform only (P=.02). Conclusions: Baseline questionnaires and use data from the first 24 hours after log-in allowed distinguishing classes, which were associated with long-term adherence. This suggests that this classification might be a useful guide to improve adherence and assign interventions to individual users. Trial Registration: ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5882-y ",
doi="10.2196/26421",
url="https://www.jmir.org/2021/6/e26421",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081012"
}


@Article{info:doi/10.2196/17858,
author="Fakih El Khoury, Cosette
and Crutzen, Rik
and Schols, MGA Jos
and Halfens, JG Ruud
and Karavetian, Mirey",
title="Adequate Management of Phosphorus in Patients Undergoing Hemodialysis Using a Dietary Smartphone App: Prospective Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="1",
volume="5",
number="6",
pages="e17858",
keywords="renal diet",
keywords="mhealth",
keywords="dietary app",
abstract="Background: The renal diet is complex and requires alterations of the diet and careful monitoring of various nutrients. Elevated serum phosphorus is common among patients undergoing hemodialysis, and it is associated with many complications. Smartphone technology could be used to support both dietitians and patients by providing a source of accessible and reliable information. Objective: The aim of this pilot is to assess the potential efficacy of an intervention using the educational and self-monitoring mobile app KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the app and a planned, rigorous large-scale trial intended to assess app efficacy. Methods: This is a prospective pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah, United Arab Emirates). All patients were assessed for eligibility and, based on inclusion criteria, considered for enrollment. Participants met with a dietitian once a week and used the mobile app regularly for 2 weeks. Outcomes (knowledge, self-reported nonadherence, dietary intake, anthropometry, and biochemical data) were measured. This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist for reporting pilot or feasibility trials. Results: Of 26 subjects, 23 successfully completed the pilot. Patient dietary knowledge about phosphorous management improved from 51.4\% (SD 13.9) to 68.1\% (SD 13.3) after intervention with a large effect size (d=1.22, 95\% CI 0.59 to 1.85). Dietary protein intake increased from a mean of 0.9 g/kg (SD 0.3) per day to a mean of 1.3 g/kg (SD 0.5) per day with a large effect size (d=1.07, 95\% CI 0.45 to 1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5 mg/g protein with a large effect size (d=0.83, 95\% CI 0.22 to 1.43). There was no evidence of change in phosphorous intake, self-reported nonadherence, and serum phosphorus. Conclusions: The findings of this prospective pilot reveal the potential efficacy of a smartphone app as a supportive nutrition education tool for phosphorus management in patients undergoing hemodialysis. This pilot study showed that the KELA.AE app has the potential to improve knowledge and dietary choices. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app use of a long-term intervention. ",
doi="10.2196/17858",
url="https://formative.jmir.org/2021/6/e17858",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061034"
}


@Article{info:doi/10.2196/25343,
author="Vandormael, Alain
and Adam, Maya
and Hachaturyan, Violetta
and Greuel, Merlin
and Favaretti, Caterina
and Gates, Jennifer
and Baernighausen, Till",
title="Reactance to Social Authority in Entertainment-Education Media: Protocol for a Web-Based Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="28",
volume="10",
number="5",
pages="e25343",
keywords="entertainment-education",
keywords="sugar reduction",
keywords="reactance",
keywords="animated video",
keywords="list experiment",
abstract="Background: Entertainment-education media can be an effective strategy for influencing health behaviors. To improve entertainment-education effectiveness, we seek to investigate whether the social authority of a person delivering a health message arouses the motivation to reject that message---a phenomenon known as reactance. Objective: In this study, using a short animated video, we aim to measure reactance to a sugar reduction message narrated by a child (low social authority), the child's mother (equivalent social authority to the target audience), and a family physician (high social authority). The aims of the study are to determine the effect of the narrator's perceived social authority on reactance to the sugar reduction message, establish the effectiveness of the video in improving behavioral intent to reduce the intake of added sugars, and quantify participants' interest in watching the entertainment-education intervention video. Methods: This is a parallel group, randomized controlled trial comparing an intervention video narrated by a low, equivalent, or high social authority against a content placebo video and a placebo video. Using a web-based recruitment platform, we plan to enroll 4000 participants aged between 18 and 59 years who speak English and reside in the United Kingdom. The primary end points will include measures of the antecedents to reactance (proneness to reactance and threat level of the message), its components (anger and negative cognition), and attitudinal and behavioral intent toward sugar intake. We will measure behavioral intent using list experiments. Participants randomized to the placebo videos will be given a choice to watch one of the sugar-intervention videos at the end of the study to assess participant engagement with the entertainment-education video. Results: The study was approved by the ethics committee of Heidelberg University on March 18, 2020 (S-088/2020). Participant recruitment and data collection were completed in December 2020. The data analysis was completed in April 2021, and the final results are planned to be published by August 2021. Conclusions: In this trial, we will use several randomization procedures, list experimentation methods, and new web-based technologies to investigate the effect of perceived social authority on reactance to a message about reducing sugar intake. Our results will inform the design of future entertainment-education videos for public health promotion needs. Trial Registration: German Clinical Trials Registry DRKS00022340: https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00022340. International Registered Report Identifier (IRRID): DERR1-10.2196/25343 ",
doi="10.2196/25343",
url="https://www.researchprotocols.org/2021/5/e25343",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047702"
}


@Article{info:doi/10.2196/25401,
author="Sinha, Ranjan
and Kachru, Dashyanng
and Ricchetti, Ray Roshni
and Singh-Rambiritch, Simitha
and Muthukumar, Marimuthu Karthik
and Singaravel, Vidhya
and Irudayanathan, Carmel
and Reddy-Sinha, Chandana
and Junaid, Imran
and Sharma, Garima
and Francis-Lyon, Alice Patricia",
title="Leveraging Genomic Associations in Precision Digital Care for Weight Loss: Cohort Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="19",
volume="23",
number="5",
pages="e25401",
keywords="obesity",
keywords="digital therapeutics",
keywords="precision nutrition",
keywords="nutrigenomics",
keywords="personalized nutrition",
keywords="mHealth",
keywords="mobile apps",
keywords="gut microbiota",
keywords="machine learning",
keywords="health coaching",
keywords="lifestyle medicine",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has highlighted the urgency of addressing an epidemic of obesity and associated inflammatory illnesses. Previous studies have demonstrated that interactions between single-nucleotide polymorphisms (SNPs) and lifestyle interventions such as food and exercise may vary metabolic outcomes, contributing to obesity. However, there is a paucity of research relating outcomes from digital therapeutics to the inclusion of genetic data in care interventions. Objective: This study aims to describe and model the weight loss of participants enrolled in a precision digital weight loss program informed by the machine learning analysis of their data, including genomic data. It was hypothesized that weight loss models would exhibit a better fit when incorporating genomic data versus demographic and engagement variables alone. Methods: A cohort of 393 participants enrolled in Digbi Health's personalized digital care program for 120 days was analyzed retrospectively. The care protocol used participant data to inform precision coaching by mobile app and personal coach. Linear regression models were fit of weight loss (pounds lost and percentage lost) as a function of demographic and behavioral engagement variables. Genomic-enhanced models were built by adding 197 SNPs from participant genomic data as predictors and refitted using Lasso regression on SNPs for variable selection. Success or failure logistic regression models were also fit with and without genomic data. Results: Overall, 72.0\% (n=283) of the 393 participants in this cohort lost weight, whereas 17.3\% (n=68) maintained stable weight. A total of 142 participants lost 5\% bodyweight within 120 days. Models described the impact of demographic and clinical factors, behavioral engagement, and genomic risk on weight loss. Incorporating genomic predictors improved the mean squared error of weight loss models (pounds lost and percent) from 70 to 60 and 16 to 13, respectively. The logistic model improved the pseudo R2 value from 0.193 to 0.285. Gender, engagement, and specific SNPs were significantly associated with weight loss. SNPs within genes involved in metabolic pathways processing food and regulating fat storage were associated with weight loss in this cohort: rs17300539\_G (insulin resistance and monounsaturated fat metabolism), rs2016520\_C (BMI, waist circumference, and cholesterol metabolism), and rs4074995\_A (calcium-potassium transport and serum calcium levels). The models described greater average weight loss for participants with more risk alleles. Notably, coaching for dietary modification was personalized to these genetic risks. Conclusions: Including genomic information when modeling outcomes of a digital precision weight loss program greatly enhanced the model accuracy. Interpretable weight loss models indicated the efficacy of coaching informed by participants' genomic risk, accompanied by active engagement of participants in their own success. Although large-scale validation is needed, our study preliminarily supports precision dietary interventions for weight loss using genetic risk, with digitally delivered recommendations alongside health coaching to improve intervention efficacy. ",
doi="10.2196/25401",
url="https://www.jmir.org/2021/5/e25401",
url="http://www.ncbi.nlm.nih.gov/pubmed/33849843"
}


@Article{info:doi/10.2196/24236,
author="Clarke, Holly
and Clark, Stephen
and Birkin, Mark
and Iles-Smith, Heather
and Glaser, Adam
and Morris, A. Michelle",
title="Understanding Barriers to Novel Data Linkages: Topic Modeling of the Results of the LifeInfo Survey",
journal="J Med Internet Res",
year="2021",
month="May",
day="17",
volume="23",
number="5",
pages="e24236",
keywords="topic modeling",
keywords="text analysis",
keywords="lifestyle data",
keywords="consumer data",
keywords="mHealth",
keywords="loyalty card",
keywords="fitness tracker",
keywords="data linkage",
keywords="data sharing",
keywords="public attitudes",
keywords="public opinion",
abstract="Background: Novel consumer and lifestyle data, such as those collected by supermarket loyalty cards or mobile phone exercise tracking apps, offer numerous benefits for researchers seeking to understand diet- and exercise-related risk factors for diseases. However, limited research has addressed public attitudes toward linking these data with individual health records for research purposes. Data linkage, combining data from multiple sources, provides the opportunity to enhance preexisting data sets to gain new insights. Objective: The aim of this study is to identify key barriers to data linkage and recommend safeguards and procedures that would encourage individuals to share such data for potential future research. Methods: The LifeInfo Survey consulted the public on their attitudes toward sharing consumer and lifestyle data for research purposes. Where barriers to data sharing existed, participants provided unstructured survey responses detailing what would make them more likely to share data for linkage with their health records in the future. The topic modeling technique latent Dirichlet allocation was used to analyze these textual responses to uncover common thematic topics within the texts. Results: Participants provided responses related to sharing their store loyalty card data (n=2338) and health and fitness app data (n=1531). Key barriers to data sharing identified through topic modeling included data safety and security, personal privacy, requirements of further information, fear of data being accessed by others, problems with data accuracy, not understanding the reason for data linkage, and not using services that produce these data. We provide recommendations for addressing these issues to establish the best practice for future researchers interested in using these data. Conclusions: This study formulates a large-scale consultation of public attitudes toward this kind of data linkage, which is an important first step in understanding and addressing barriers to participation in research using novel consumer and lifestyle data. ",
doi="10.2196/24236",
url="https://www.jmir.org/2021/5/e24236",
url="http://www.ncbi.nlm.nih.gov/pubmed/33998998"
}


@Article{info:doi/10.2196/15649,
author="Robert, Caroline
and Erdt, Mojisola
and Lee, James
and Cao, Yuanyuan
and Naharudin, Binte Nurhazimah
and Theng, Yin-Leng",
title="Effectiveness of eHealth Nutritional Interventions for Middle-Aged and Older Adults: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="May",
day="17",
volume="23",
number="5",
pages="e15649",
keywords="eHealth",
keywords="mHealth",
keywords="nutritional intervention",
keywords="nutrition apps",
keywords="middle-aged",
keywords="older adults",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: The risk of development of chronic diseases related to poor nutrition increases with age. In the face of an aging population, it is important for health care sectors to find solutions in delivering health services efficiently and effectively to middle-aged and older adults. Objective: The aim of this systematic review and meta-analysis was to consolidate the literature that reported the effectiveness of eHealth apps in delivering nutritional interventions for middle-aged and older adults. Methods: A literature search from five databases (PubMed, CINAHL, Cochrane, Web of Science, and Global Health) from the past 5 years was performed. Studies were selected for inclusion that used eHealth to deliver nutritional interventions to adults aged 40 years and above, and reported health and behavioral outcomes. Two independent reviewers searched for research articles and assessed the eligibility of studies to be included in the review. A third reviewer resolved disagreements on study inclusion. We also assessed the quality of the included studies using the CONSORT 2010 checklist. Results: A total of 70 studies were included for analysis. The study quality ranged from 44\% to 85\%. The most commonly used eHealth intervention type was mobile apps (22/70, 31\%). The majority of studies (62/70, 89\%) provided multicomponent health interventions, which aimed to improve nutrition and other health behaviors (eg, exercise, smoking cessation, medication adherence). Meta-analysis results indicated high and significant heterogeneity; hence, conclusions based on these results should be considered with caution. Nonetheless, the results generally showed that eHealth interventions improved anthropometric and clinical outcomes, but not behavioral outcomes such as fruit and vegetable consumption. Conclusions: The use of eHealth apps to deliver health interventions has been increasing in recent years, and these apps have the potential to deliver health services to a larger group of people. Our findings showed that the effectiveness of eHealth apps to deliver health interventions for middle-aged to older adults was supported by the improvement of anthropometric and clinical outcomes. Future work could aim to develop research frameworks in administering eHealth interventions to address heterogeneity in this field of research. ",
doi="10.2196/15649",
url="https://www.jmir.org/2021/5/e15649",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999005"
}


@Article{info:doi/10.2196/25371,
author="Lorenz, Arnold Kent
and Yeshurun, Shlomo
and Aziz, Richard
and Ortiz-Delatorre, Julissa
and Bagley, Robert James
and Mor, Merav
and Kern, Marialice",
title="A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study",
journal="Interact J Med Res",
year="2021",
month="May",
day="17",
volume="10",
number="2",
pages="e25371",
keywords="resting metabolic rate",
keywords="Lumen",
keywords="ParvoMedics TrueOne 2400",
keywords="validation",
keywords="respiratory exchange ratio",
keywords="metabolism",
keywords="fuel utilization",
keywords="indirect calorimetry",
keywords="breath",
keywords="lung",
keywords="respiratory",
keywords="young adult",
keywords="measurement",
keywords="testing",
abstract="Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as \% CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen \% CO2. Results: Both RER and Lumen \% CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. ",
doi="10.2196/25371",
url="https://www.i-jmr.org/2021/2/e25371",
url="http://www.ncbi.nlm.nih.gov/pubmed/33870899"
}


@Article{info:doi/10.2196/24802,
author="Karssen, T. Levie
and Vink, M. Jacqueline
and de Weerth, Carolina
and Hermans, J. Roel C.
and de Kort, M. Carina P.
and Kremers, PJ Stef
and Ruiter, M. Emilie L.
and Larsen, K. Junilla",
title="An App-Based Parenting Program to Promote Healthy Energy Balance--Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework",
journal="JMIR Form Res",
year="2021",
month="May",
day="14",
volume="5",
number="5",
pages="e24802",
keywords="childhood obesity",
keywords="preventive intervention",
keywords="parenting practices",
keywords="energy-balance related behavior",
keywords="socio-economic position",
keywords="mHealth",
keywords="behavior change",
keywords="mobile phone",
abstract="Background: The family environment plays an important role in the development of children's energy balance--related behaviors. As a result, parents' energy balance--related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance--related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance--related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance--related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. ",
doi="10.2196/24802",
url="https://formative.jmir.org/2021/5/e24802",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988510"
}


@Article{info:doi/10.2196/17189,
author="Greene, M. Ellen
and O'Brien, C. Eileen
and Kennelly, A. Maria
and O'Brien, A. Orna
and Lindsay, L. Karen
and McAuliffe, M. Fionnuala",
title="Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="12",
volume="9",
number="5",
pages="e17189",
keywords="pregnancy",
keywords="mHealth",
keywords="nutrition",
keywords="lifestyle",
keywords="acceptability",
keywords="app",
keywords="mobile phone",
abstract="Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5\%), enjoyable (106/148, 74.1\%), and affordable (110/148, 76.9\%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0\%) and easy to use (116/119, 97.5\%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 ",
doi="10.2196/17189",
url="https://mhealth.jmir.org/2021/5/e17189",
url="http://www.ncbi.nlm.nih.gov/pubmed/33978597"
}


@Article{info:doi/10.2196/26163,
author="Potzel, Lotte Anne
and Gar, Christina
and Seissler, Jochen
and Lechner, Andreas",
title="A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="11",
volume="9",
number="5",
pages="e26163",
keywords="mHealth",
keywords="diabetes prevention",
keywords="health behavior",
keywords="cardiometabolic disease",
keywords="gestational diabetes mellitus",
keywords="smartphone app",
keywords="intervention mapping",
abstract="Background: Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. Objective: The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women's expected standards of commercial health apps. Methods: The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app (``TRIANGLE'') was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. Results: The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features---a challenge system, human coaching, and a library---address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. Conclusions: The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Trial Registration: German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736 ",
doi="10.2196/26163",
url="https://mhealth.jmir.org/2021/5/e26163",
url="http://www.ncbi.nlm.nih.gov/pubmed/33973864"
}


@Article{info:doi/10.2196/23809,
author="Graham, K. Andrea
and Munson, A. Sean
and Reddy, Madhu
and Neubert, W. Sarah
and Green, A. Emilie
and Chang, Angela
and Spring, Bonnie
and Mohr, C. David
and Wildes, E. Jennifer",
title="Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis",
journal="JMIR Form Res",
year="2021",
month="May",
day="10",
volume="5",
number="5",
pages="e23809",
keywords="obesity",
keywords="binge eating",
keywords="user-centered design",
keywords="mobile intervention",
keywords="engagement",
keywords="experimental therapeutics",
abstract="Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32\% non-Hispanic White; 8/22, 36\% male) with self-reported obesity and recurrent binge eating (?12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82\% (18/22) struggled with implementation, and 23\% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82\% (18/22) indicated the strategy was helpful, and 86\% (19/22) planned to continue use. One-week average within-subject changes in weight (--2.2 [SD --5.0] pounds) and binge eating (--1.6 [SD --1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. ",
doi="10.2196/23809",
url="https://formative.jmir.org/2021/5/e23809",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970114"
}


@Article{info:doi/10.2196/22990,
author="Mauch, E. Chelsea
and Laws, A. Rachel
and Prichard, Ivanka
and Maeder, J. Anthony
and Wycherley, P. Thomas
and Golley, K. Rebecca",
title="Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="7",
volume="9",
number="5",
pages="e22990",
keywords="diet",
keywords="nutrition",
keywords="family",
keywords="mobile applications",
keywords="behavior modification",
abstract="Background: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. Objective: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. Methods: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4\%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. Results: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7\%) and partnered (122/133, 91.7\%). Participants identified a need for healthy recipes (109/133, 82\% agreed or strongly agreed) and time for food provision processes (107/133, 80.5\%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. Conclusions: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time. ",
doi="10.2196/22990",
url="https://mhealth.jmir.org/2021/5/e22990",
url="http://www.ncbi.nlm.nih.gov/pubmed/33960951"
}


@Article{info:doi/10.2196/22929,
author="Yong, Y. Joceline Y.
and Tong, W. Eddie M.
and Liu, J. Jean C.",
title="Meal-time Smartphone Use in an Obesogenic Environment: Two Longitudinal Observational Studies",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="6",
volume="9",
number="5",
pages="e22929",
keywords="screen time",
keywords="mobile phones",
keywords="technology",
keywords="obesogenic environment",
keywords="young adults",
abstract="Background: Despite a large volume of research on the impact of other digital screens (eg, televisions) on eating behavior, little is known about the nature and impact of mealtime smartphone use. Objective: We investigated how smartphones are used in everyday meals, whether phone users differ according to mealtime phone use patterns, and whether specific phone functions (particularly food photography) would affect the amount and enjoyment of food eaten. Methods: Across 2 studies, we used the experience sampling method to track 1780 meals in situ. In study 1, a total 137 young adults reported on their mealtime smartphone use 3 times per day over 7 consecutive days. This corresponded to each main meal, with participants recording whether they used their phones and what phone functions they engaged in while eating. In study 2, a total of 71 young adults were similarly tracked for 3 meals per day over 7 days. Across the week, participants' meals were randomized to 1 of 3 smartphone conditions: food photography while eating, nonfood photography while eating, or no phone use. As the outcome measures, participants reported on the amount and enjoyment of food they ate. Results: During the week-long tracking, most participants (110/129, 85.3\%) recorded at least one instance of mealtime smartphone use, with an average frequency of 1 in 3 meals where phones were used (27.1\%; 95\% CI 23.6-30.6). Unlike traditional digital screens, mealtime phone use encompassed a wide range of social and nonsocial activities. Further, specific forms of phone use behaviors influenced food intake in different ways. Specifically, in study 2, participants showed the typical pattern of increased food intake across the day when they engaged in nonfood photography during a meal (P<.001); however, this pattern was disrupted when they engaged in food photography (P=.73). Conclusions: Our findings underscore the prevalence and multifaceted nature of mealtime phone use, distinguishing mobile phones from traditional forms of digital screens. Trial Registration: ClinicalTrials.gov NCT03299075; https://www.clinicaltrials.gov/ct2/show/NCT03299075 and ClinicalTrials.gov NCT03346785; https://clinicaltrials.gov/ct2/show/NCT03346785 ",
doi="10.2196/22929",
url="https://mhealth.jmir.org/2021/5/e22929",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955842"
}


@Article{info:doi/10.2196/23974,
author="Fahey, C. Margaret
and Klesges, C. Robert
and Kocak, Mehmet
and Gladney, A. Leslie
and Talcott, W. Gerald
and Krukowski, A. Rebecca",
title="Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis",
journal="JMIR Form Res",
year="2021",
month="May",
day="5",
volume="5",
number="5",
pages="e23974",
keywords="technology-based intervention",
keywords="counselor communication",
keywords="counselor feedback",
keywords="counselor",
keywords="weight loss",
keywords="lifestyle",
keywords="wellness",
abstract="Background: Feedback for participants' self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. Objective: The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. Methods: The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. Results: There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). Conclusions: Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. Trial Registration: ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178 ",
doi="10.2196/23974",
url="https://formative.jmir.org/2021/5/e23974",
url="http://www.ncbi.nlm.nih.gov/pubmed/33949954"
}


@Article{info:doi/10.2196/22487,
author="Frija-Masson, Justine
and Mullaert, Jimmy
and Vidal-Petiot, Emmanuelle
and Pons-Kerjean, Nathalie
and Flamant, Martin
and d'Ortho, Marie-Pia",
title="Accuracy of Smart Scales on Weight and Body Composition: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="30",
volume="9",
number="4",
pages="e22487",
keywords="smart scales",
keywords="DEXA",
keywords="obesity",
abstract="Background: Smart scales are increasingly used at home by patients to monitor their body weight and body composition, but scale accuracy has not often been documented. Objective: The goal of the research was to determine the accuracy of 3 commercially available smart scales for weight and body composition compared with dual x-ray absorptiometry (DEXA) as the gold standard. Methods: We designed a cross-sectional study in consecutive patients evaluated for DEXA in a physiology unit in a tertiary hospital in France. There were no exclusion criteria except patient declining to participate. Patients were weighed with one smart scale immediately after DEXA. Three scales were compared (scale 1: Body Partner [T{\'e}fal], scale 2: DietPack [Terraillon], and scale 3: Body Cardio [Nokia Withings]). We determined absolute error between the gold standard values obtained from DEXA and the smart scales for body mass, fat mass, and lean mass. Results: The sample for analysis included 53, 52, and 48 patients for each of the 3 tested smart scales, respectively. The median absolute error for body weight was 0.3 kg (interquartile range [IQR] --0.1, 0.7), 0 kg (IQR --0.4, 0.3), and 0.25 kg (IQR --0.10, 0.52), respectively. For fat mass, absolute errors were --2.2 kg (IQR --5.8, 1.3), --4.4 kg (IQR --6.6, 0), and --3.7 kg (IQR --8.0, 0.28), respectively. For muscular mass, absolute errors were --2.2 kg (IQR --5.8, 1.3), --4.4 kg (IQR --6.6, 0), and --3.65 kg (IQR --8.03, 0.28), respectively. Factors associated with fat mass measurement error were weight for scales 1 and 2 (P=.03 and P<.001, respectively), BMI for scales 1 and 2 (P=.034 and P<.001, respectively), body fat for scale 1 (P<.001), and muscular and bone mass for scale 2 (P<.001 for both). Factors associated with muscular mass error were weight and BMI for scale 1 (P<.001 and P=.004, respectively), body fat for scales 1 and 2 (P<.001 for both), and muscular and bone mass for scale 2 (P<.001 and P=.002, respectively). Conclusions: Smart scales are not accurate for body composition and should not replace DEXA in patient care. Trial Registration: ClinicalTrials.gov NCT03803098; https://clinicaltrials.gov/ct2/show/NCT03803098 ",
doi="10.2196/22487",
url="https://mhealth.jmir.org/2021/4/e22487",
url="http://www.ncbi.nlm.nih.gov/pubmed/33929337"
}


@Article{info:doi/10.2196/25160,
author="Ze{\v c}evi{\'c}, Mila
and Mijatovi{\'c}, Dejan
and Kos Kokli{\v c}, Mateja
and ?abkar, Vesna
and Gidakovi{\'c}, Petar",
title="User Perspectives of Diet-Tracking Apps: Reviews Content Analysis and Topic Modeling",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="22",
volume="23",
number="4",
pages="e25160",
keywords="diet-tracking apps",
keywords="mobile apps",
keywords="user reviews",
keywords="topic modeling",
keywords="n-grams",
keywords="mHealth",
keywords="nutrition",
keywords="diet",
keywords="well-being",
abstract="Background: The availability and use of mobile apps in health and nutrition management are increasing. Ease of access and user friendliness make diet-tracking apps an important ally in their users' efforts to lose and manage weight. To foster motivation for long-term use and to achieve goals, it is necessary to better understand users' opinions and needs for dietary self-monitoring. Objective: The aim of this study was to identify the key topics and issues that users highlight in their reviews of diet-tracking apps on Google Play Store. Identifying the topics that users frequently mention in their reviews of these apps, along with the user ratings for each of these apps, allowed us to identify areas where further improvement of the apps could facilitate app use, and support users' weight loss and intake management efforts. Methods: We collected 72,084 user reviews from Google Play Store for 15 diet-tracking apps that allow users to track and count calories. After a series of text processing operations, two text-mining techniques (topic modeling and topical n-grams) were applied to the corpus of user reviews of diet-tracking apps. Results: Using the topic modeling technique, 11 separate topics were extracted from the pool of user reviews. Most of the users providing feedback were generally satisfied with the apps they use (average rating of 4.4 out of 5 for the 15 apps). Most topics referred to the positive evaluation of the apps and their functions. Negatively rated topics mostly referred to app charges and technical difficulties encountered. We identified the positive and negative topic trigrams (3-word combinations) among the most frequently mentioned topics. Usability and functionality (tracking options) of apps were rated positively on average. Negative ratings were associated with trigrams related to adding new foods, technical issues, and app charges. Conclusions: Motivating users to use an app over time could help them better achieve their nutrition goals. Although user reviews generally showed positive opinions and ratings of the apps, developers should pay more attention to users' technical problems and inform users about expected payments, along with their refund and cancellation policies, to increase user loyalty. ",
doi="10.2196/25160",
url="https://www.jmir.org/2021/4/e25160",
url="http://www.ncbi.nlm.nih.gov/pubmed/33885375"
}


@Article{info:doi/10.2196/25228,
author="Karbownik, Seweryn Micha?
and Horne, Robert
and Paul, Ewelina
and Kowalczyk, Edward
and Szemraj, Janusz",
title="Determinants of Knowledge About Dietary Supplements Among Polish Internet Users: Nationwide Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="21",
volume="23",
number="4",
pages="e25228",
keywords="dietary supplements",
keywords="knowledge",
keywords="beliefs",
keywords="advertising",
keywords="education",
keywords="statistical model",
keywords="health services",
keywords="Poland",
keywords="online social networking",
abstract="Background: An accurate understanding of dietary supplements (DS) is a prerequisite for informed decisions regarding their intake. However, there is a need for studies on this understanding among the public based on validated research tools. Objective: This study aims to assess the knowledge about DS among Polish internet users with no medical education and to identify its determinants and design an appropriate predictive model. Methods: The study protocol was prospectively registered with a statistical analysis plan. Polish users of a web-based health service and a social networking service were administered a survey consisting of the recently developed questionnaire on knowledge about DS, the questionnaire on trust in advertising DS, the beliefs about medicines questionnaire, and several other health-related single-item measures and sociodemographic questions. The results were subjected to general linear modeling. Results: A total of 6273 participants were included. Of the 17 yes or no questions in the questionnaire of knowledge about DS, the mean number of correct responses was 9.0 (95\% CI 8.9-9.1). Health service users performed worse than social networking users by 2.3 points (95\% CI 2.1-2.5) in an analysis adjusted for potential confounders. Internet users had fewer true beliefs about DS if they presented higher trust in their advertising (adjusted $\beta$=?.37; 95\% CI ?.39 to ?.34), used DS (adjusted $\beta$=?.14; 95\% CI ?.17 to ?.12), experienced their positive effect (adjusted $\beta$=?.16; 95\% CI ?.18 to ?.13), were older or younger than 35 years (adjusted $\beta$=?.14; 95\% CI ?.17 to ?.12), expressed interest in the topic of DS (adjusted $\beta$=?.10; 95\% CI ?.13 to ?.08), reported getting information about the products from friends (adjusted $\beta$=?.13; 95\% CI ?.15 to ?.11), and believed that medicines are harmful (adjusted $\beta$=?.12; 95\% CI ?.15 to ?.10). The proposed 5-predictor model could explain 31.2\% of the variance in knowledge about DS. The model appeared resistant to overfitting and was able to forecast most of the observed associations. Conclusions: Polish internet users with no medical education exhibit some false beliefs regarding DS. Trusting the advertising of DS appears to conflict with knowledge about them. There is an urgent need for effective web-based educational campaigns on DS and the promotion of advertising literacy. After the proposed predictive model is externally validated, it may help identify the least informed target audience. ",
doi="10.2196/25228",
url="https://www.jmir.org/2021/4/e25228",
url="http://www.ncbi.nlm.nih.gov/pubmed/33658173"
}


@Article{info:doi/10.2196/25757,
author="Cheng, Xiaolu
and Lin, Shuo-Yu
and Wang, Kevin
and Hong, Alicia Y.
and Zhao, Xiaoquan
and Gress, Dustin
and Wojtusiak, Janusz
and Cheskin, J. Lawrence
and Xue, Hong",
title="Healthfulness Assessment of Recipes Shared on Pinterest: Natural Language Processing and Content Analysis",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="20",
volume="23",
number="4",
pages="e25757",
keywords="healthfulness assessment",
keywords="recipes on Pinterest",
keywords="social networks",
keywords="natural language processing",
abstract="Background: Although Pinterest has become a popular platform for distributing influential information that shapes users' behaviors, the role of recipes pinned on Pinterest in these behaviors is not well understood. Objective: This study aims to explore the patterns of food ingredients and the nutritional content of recipes posted on Pinterest and to examine the factors associated with recipes that engage more users. Methods: Data were collected from Pinterest between June 28 and July 12, 2020 (207 recipes and 2818 comments). All samples were collected via 2 new user accounts with no search history. A codebook was developed with a raw agreement rate of 0.97 across all variables. Content analysis and natural language processing sentiment analysis techniques were employed. Results: Recipes using seafood or vegetables as the main ingredient had, on average, fewer calories and less sodium, sugar, and cholesterol than meat- or poultry-based recipes. For recipes using meat as the main ingredient, more than half of the energy was obtained from fat (277/490, 56.6\%). Although the most followed pinners tended to post recipes containing more poultry or seafood and less meat, recipes with higher fat content or providing more calories per serving were more popular, having more shared photos or videos and comments. The natural language processing--based sentiment analysis suggested that Pinterest users weighted taste more heavily than complexity (225/2818, 8.0\%) and health (84/2828, 2.9\%). Conclusions: Although popular pinners tended to post recipes with more seafood or poultry or vegetables and less meat, recipes with higher fat and sugar content were more user-engaging, with more photo or video shares and comments. Data on Pinterest behaviors can inform the development and implementation of nutrition health interventions to promote healthy recipe sharing on social media platforms. ",
doi="10.2196/25757",
url="https://www.jmir.org/2021/4/e25757",
url="http://www.ncbi.nlm.nih.gov/pubmed/33877052"
}


@Article{info:doi/10.2196/17503,
author="Asensio-Cuesta, Sabina
and Blanes-Selva, Vicent
and Conejero, Alberto J.
and Frigola, Ana
and Portol{\'e}s, G. Manuel
and Merino-Torres, Francisco Juan
and Rubio Almanza, Matilde
and Syed-Abdul, Shabbir
and Li, (Jack) Yu-Chuan
and Vilar-Mateo, Ruth
and Fernandez-Luque, Luis
and Garc{\'i}a-G{\'o}mez, M. Juan",
title="A User-Centered Chatbot (Wakamola) to Collect Linked Data in Population Networks to Support Studies of Overweight and Obesity Causes: Design and Pilot Study",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="14",
volume="9",
number="4",
pages="e17503",
keywords="mHealth",
keywords="obesity",
keywords="overweight",
keywords="chatbot",
keywords="assessment",
keywords="public health",
keywords="Telegram",
keywords="user-centered design",
keywords="Social Network Analysis",
abstract="Background: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. Objective: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. Methods: We first studied the users' needs and gathered users' graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. Results: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11\%), 5 overweight people (7\%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. Conclusions: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives. ",
doi="10.2196/17503",
url="https://medinform.jmir.org/2021/4/e17503",
url="http://www.ncbi.nlm.nih.gov/pubmed/33851934"
}


@Article{info:doi/10.2196/24998,
author="Langlet, Sundstr{\"o}m Billy
and Odegi, Dorothy
and Zandian, Modjtaba
and Nolstam, Jenny
and S{\"o}dersten, Per
and Bergh, Cecilia",
title="Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study",
journal="JMIR Serious Games",
year="2021",
month="Apr",
day="13",
volume="9",
number="2",
pages="e24998",
keywords="feeding and eating disorders",
keywords="anorexia nervosa",
keywords="bulimia nervosa",
keywords="binge eating disorder",
keywords="immersive virtual reality",
keywords="eating disorders",
keywords="virtual reality",
abstract="Background: Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50\%, a dropout rate from 20\% to 50\%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders. Objective: The aim of this study was to evaluate the feasibility and usability of an immersive virtual reality technology administered through an app for use by patients with eating disorders. Methods: Twenty-six participants, including 19 eating disorder clinic personnel and 5 information technology personnel, were recruited through emails and personal invitations. Participants handled virtual food and utensils on an app using immersive virtual reality technology comprising a headset and two hand controllers. In the app, the participants learned about the available actions through a tutorial and they were introduced to a food challenge. The challenge consisted of a meal type (meatballs, potatoes, sauce, and lingonberries) that is typically difficult for patients with anorexia nervosa to eat in real life. Participants were instructed, via visual feedback from the app, to eat at a healthy rate, which is also a challenge for patients. Participants rated the feasibility and usability of the app by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usability Scale, and the 20-point heuristic evaluation questionnaire. A cognitive walkthrough was performed using video recordings of participant interactions in the virtual environment. Results: The mean age of participants was 37.9 (SD 9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggested that implementation of the app would face minor infrastructural, technological, interoperability, financial, and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use; however, most of the participants agreed that the app should be used at least once per week. The app received a mean score of 73.4 (range 55-90), earning an overall ``good'' rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6 out of 5. The lowest score (2.6) was given to the ``accuracy'' item. During the cognitive walkthrough, 32\% of the participants displayed difficulty in understanding what to do at the initial selection screen. However, after passing the selection screen, all participants understood how to progress through the tasks. Conclusions: Participants found the app to be usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges in the current app, participants considered that the app requires improvement to offer environmental and social (eg, crowded room vs eating alone) challenges. ",
doi="10.2196/24998",
url="https://games.jmir.org/2021/2/e24998",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847593"
}


@Article{info:doi/10.2196/24690,
author="Xu, Ran
and Cavallo, David",
title="Social Network Analysis of the Effects of a Social Media--Based Weight Loss Intervention Targeting Adults of Low Socioeconomic Status: Single-Arm Intervention Trial",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="9",
volume="23",
number="4",
pages="e24690",
keywords="weight loss intervention",
keywords="social media intervention",
keywords="electronic health",
keywords="social network analysis",
abstract="Background: Obesity is a known risk factor for cardiovascular disease risk factors, including hypertension and type II diabetes. Although numerous weight loss interventions have demonstrated efficacy, there is considerably less evidence about the theoretical mechanisms through which they work. Delivering lifestyle behavior change interventions via social media provides unique opportunities for understanding mechanisms of intervention effects. Server data collected directly from web-based platforms can provide detailed, real-time behavioral information over the course of intervention programs that can be used to understand how interventions work. Objective: The objective of this study was to demonstrate how social network analysis can facilitate our understanding of the mechanisms underlying a social media--based weight loss intervention. Methods: We performed secondary analysis by using data from a pilot study that delivered a dietary and physical activity intervention to a group of participants via Facebook. We mapped out participants' interaction networks over the 12-week intervention period and linked participants' network characteristics (eg, in-degree, out-degree, network constraint) to participants' changes in theoretical mediators (ie, dietary knowledge, perceived social support, self-efficacy) and weight loss by using regression analysis. We also performed mediation analyses to explore how the effects of social network measures on weight loss could be mediated by the aforementioned theoretical mediators. Results: In this analysis, 47 participants from 2 waves completed the study and were included. We found that increases in the number of posts, comments, and reactions significantly predicted weight loss ($\beta$=--.94, P=.04); receiving comments positively predicted changes in self-efficacy ($\beta$=7.81, P=.009), and the degree to which one's network neighbors are tightly connected with each other weakly predicted changes in perceived social support ($\beta$=7.70, P=.08). In addition, change in self-efficacy mediated the relationship between receiving comments and weight loss ($\beta$=--.89, P=.02). Conclusions: Our analyses using data from this pilot study linked participants' network characteristics with changes in several important study outcomes of interest such as self-efficacy, social support, and weight. Our results point to the potential of using social network analysis to understand the social processes and mechanisms through which web-based behavioral interventions affect participants' psychological and behavioral outcomes. Future studies are warranted to validate our results and to further explore the relationship between network dynamics and study outcomes in similar and larger trials. ",
doi="10.2196/24690",
url="https://www.jmir.org/2021/4/e24690",
url="http://www.ncbi.nlm.nih.gov/pubmed/33835033"
}


@Article{info:doi/10.2196/22759,
author="Timon, M. Claire
and Walton, Janette
and Flynn, Albert
and Gibney, R. Eileen",
title="Respondent Characteristics and Dietary Intake Data Collected Using Web-Based and Traditional Nutrition Surveillance Approaches: Comparison and Usability Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="7",
volume="7",
number="4",
pages="e22759",
keywords="diet",
keywords="survey and questionnaire",
keywords="technology",
keywords="nutrition surveillance",
abstract="Background: There are many constraints to conducting national food consumption surveys for national nutrition surveillance, including cost, time, and participant burden. Validated web-based dietary assessment technologies offer a potential solution to many of these constraints. Objective: This study aims to investigate the feasibility of using a previously validated, web-based, 24-hour recall dietary assessment tool (Foodbook24) for nutrition surveillance by comparing the demographic characteristics and the quality of dietary intake data collected from a web-based cohort of participants in Ireland to those collected from the most recent Irish National Adult Nutrition Survey (NANS). Methods: Irish adult participants (aged ?18 years) were recruited to use Foodbook24 (a web-based tool) between March and October 2016. Demographic and dietary intake (assessed by means of 2 nonconsecutive, self-administered, 24-hour recalls) data were collected using Foodbook24. Following the completion of the study, the dietary intake data collected from the web-based study were statistically weighted to represent the age-gender distribution of intakes reported in the NANS (2008-2010) to facilitate the controlled comparison of intake data. The demographic characteristics of the survey respondents were investigated using descriptive statistics. The controlled comparison of weighted mean daily nutrient intake data collected from the Foodbook24 web-based study (329 plausible reporters of a total of 545 reporters) and the mean daily nutrient intake data collected from the NANS (1051 plausible reporters from 1500 reporters) was completed using the Wilcoxon--Mann-Whitney U test in Creme Nutrition software. Results: Differences between the demographic characteristics of the survey participants across the 2 surveys were observed. Notable differences included a lower proportion of adults aged ?65 years and a higher proportion of females who participated in the web-based Foodbook24 study relative to the NANS study (P<.001). Similar ranges of mean daily intake for the majority of nutrients and food groups were observed (eg, energy [kilocalorie per day] and carbohydrate [gram per day]), although significant differences for some nutrients (eg, riboflavin [mg/10 MJ], P<.001 and vitamin B12 [{\textmu}g/10 MJ], P<.001) and food groups were identified. A high proportion of participants (200/425, 47.1\%) reported a willingness to continue using Foodbook24 for an additional 6 months. Conclusions: These findings suggest that by using targeted recruitment strategies in the future to ensure the recruitment of a more representative sample, there is potential for web-based methodologies such as Foodbook24 to be used for nutrition surveillance efforts in Ireland. ",
doi="10.2196/22759",
url="https://publichealth.jmir.org/2021/4/e22759",
url="http://www.ncbi.nlm.nih.gov/pubmed/33825694"
}


@Article{info:doi/10.2196/24249,
author="Pagoto, Sherry
and Tulu, Bengisu
and Waring, E. Molly
and Goetz, Jared
and Bibeau, Jessica
and Divito, Joseph
and Groshon, Laurie
and Schroeder, Matthew",
title="Slip Buddy App for Weight Management: Randomized Feasibility Trial of a Dietary Lapse Tracking App",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="1",
volume="9",
number="4",
pages="e24249",
keywords="mobile app",
keywords="mHealth",
keywords="weight loss",
keywords="obesity",
keywords="diet",
keywords="mobile phone",
abstract="Background: Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. Objective: This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. Methods: We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups. Results: A total of 75\% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97\% (31/32) retained in the Slip Buddy condition and 94\% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8\% (SD 31.3\%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5\%, SD 28.4\% of days), and participants who recorded slips (30/32, 94\%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9\%). Slips most often occurred at home (297/538, 55.2\%), while working (153/538, 28.4\%), while socializing (130/538, 24.2\%), or during screen time (123/538, 22.9\%). The conditions did not differ in participants' ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ?5\% of baseline weight were achieved by 31\% (10/32) of Slip Buddy participants and 34\% (11/32) of calorie tracking participants. Conclusions: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. Trial Registration: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171 ",
doi="10.2196/24249",
url="https://mhealth.jmir.org/2021/4/e24249",
url="http://www.ncbi.nlm.nih.gov/pubmed/33792547"
}


@Article{info:doi/10.2196/24871,
author="Young, Louise Claire
and Mohebbi, Mohammadreza
and Staudacher, M. Heidi
and Kay-Lambkin, Frances
and Berk, Michael
and Jacka, Nellie Felice
and O'Neil, Adrienne",
title="Optimizing Engagement in an Online Dietary Intervention for Depression (My Food \& Mood Version 3.0): Cohort Study",
journal="JMIR Ment Health",
year="2021",
month="Mar",
day="31",
volume="8",
number="3",
pages="e24871",
keywords="online intervention",
keywords="nutritional psychiatry",
keywords="depression",
keywords="low mood",
keywords="dietary intervention",
keywords="eHealth",
keywords="mHealth",
keywords="engagement",
keywords="nonusage attrition",
abstract="Background: Online interventions can be a cost-effective and efficient way to deliver programs to large numbers of people regardless of geographic location. However, attrition in web-based interventions is often an issue. Developing ways to keep participants engaged is important for ensuring validity and limiting potential biases. We developed a web-based dietary intervention as part of The My Food \& Mood study which aimed to optimize ways to engage participants with low mood or depressive symptoms to promote dietary behavior change. Different versions of the My Food \& Mood program were tested during optimization. Iterations were developed based on user feedback and usage analysis. Objective: The purpose of this study was to compare engagement and nonusage attrition across 4 program iterations---which differed by platform format, delivery mode, and activity type---to create an optimized version. Methods: Each program version contained modular videos with key activities with respect to implementing behavior change techniques of equivalent levels of required participation and length: version 1.0, desktop program and smartphone app; version 2.1, desktop or smartphone program; version 2.2, desktop program; and version 3.0, smartphone app. Adults with PHQ-8 scores of 5 or greater were recruited online and assigned to 1 of the 4 versions. Participants were asked to use the program for 8 weeks and complete measures at weeks 4 and 8. Engagement data were collected from the web-based platform system logs and customized reports. Cox regression survival analysis examined nonusage attrition and Kruskal-Wallis tests compared engagement across each cohort. Results: A total of 614 adults participated. Kruskal-Wallis tests showed significant differences across the 4 cohorts in all engagement measures. The smartphone app (version 3.0) had the greatest engagement as measured by weeks engaged, total usage time, total time key activities, number of active sessions, percentage of activities completed against protocol, goals completed, and percentage of videos watched. Cox regression multivariate survival analysis showed referral from a health practitioner (hazard ratio [HR] 0.344, P=.001) and greater proficiency with computers (HR 0.796, P=.049) reduced the risk of nonusage attrition. Computer confidence was associated with an increased risk of nonusage attrition. Conclusions: My Food \& Mood version 3.0, a dietary intervention delivered via smartphone app with self-monitoring tools for diet quality and mood monitoring, was the version with greatest engagement in a population with low mood or depression. The iterative design techniques employed and analysis of feedback from participants resulted in a program that achieved lower rates of nonusage attrition and higher rates of intensity of use. ",
doi="10.2196/24871",
url="https://mental.jmir.org/2021/3/e24871",
url="http://www.ncbi.nlm.nih.gov/pubmed/33787501"
}


@Article{info:doi/10.2196/25699,
author="Gamble, Abigail
and Beech, M. Bettina
and Wade, C. Breanna
and Sutton, D. Victor
and Lim, Crystal
and Sandridge, Shanda
and Welsch, A. Michael",
title="Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="31",
volume="10",
number="3",
pages="e25699",
keywords="prediabetic state",
keywords="child obesity",
keywords="telehealth",
keywords="obesity management",
keywords="behavioral science",
keywords="implementation science",
keywords="Jackson Heart Study",
keywords="Centers for Disease Control and Prevention",
keywords="preventive medicine",
keywords="mobile phone",
abstract="Background: In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective: This study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center's (UMMC) pediatric weight management clinic. Methods: This single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi--enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC's pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change. Results: Recruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC's Institutional Review Board (\#2020V0249). Conclusions: The proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations. International Registered Report Identifier (IRRID): PRR1-10.2196/25699 ",
doi="10.2196/25699",
url="https://www.researchprotocols.org/2021/3/e25699",
url="http://www.ncbi.nlm.nih.gov/pubmed/33787504"
}


@Article{info:doi/10.2196/22183,
author="Kim, Heon Ho
and Kim, Youngin
and Park, Rang Yu",
title="Interpretable Conditional Recurrent Neural Network for Weight Change Prediction: Algorithm Development and Validation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="29",
volume="9",
number="3",
pages="e22183",
keywords="explainable AI",
keywords="interpretable AI",
keywords="mHealth",
keywords="obesity",
keywords="behavior modification",
keywords="artificial intelligence",
keywords="development",
keywords="validation",
keywords="weight",
keywords="intervention",
abstract="Background: In recent years, mobile-based interventions have received more attention as an alternative to on-site obesity management. Despite increased mobile interventions for obesity, there are lost opportunities to achieve better outcomes due to the lack of a predictive model using current existing longitudinal and cross-sectional health data. Noom (Noom Inc) is a mobile app that provides various lifestyle-related logs including food logging, exercise logging, and weight logging. Objective: The aim of this study was to develop a weight change predictive model using an interpretable artificial intelligence algorithm for mobile-based interventions and to explore contributing factors to weight loss. Methods: Lifelog mobile app (Noom) user data of individuals who used the weight loss program for 16 weeks in the United States were used to develop an interpretable recurrent neural network algorithm for weight prediction that considers both time-variant and time-fixed variables. From a total of 93,696 users in the coaching program, we excluded users who did not take part in the 16-week weight loss program or who were not overweight or obese or had not entered weight or meal records for the entire 16-week program. This interpretable model was trained and validated with 5-fold cross-validation (training set: 70\%; testing: 30\%) using the lifelog data. Mean absolute percentage error between actual weight loss and predicted weight was used to measure model performance. To better understand the behavior factors contributing to weight loss or gain, we calculated contribution coefficients in test sets. Results: A total of 17,867 users' data were included in the analysis. The overall mean absolute percentage error of the model was 3.50\%, and the error of the model declined from 3.78\% to 3.45\% by the end of the program. The time-level attention weighting was shown to be equally distributed at 0.0625 each week, but this gradually decreased (from 0.0626 to 0.0624) as it approached 16 weeks. Factors such as usage pattern, weight input frequency, meal input adherence, exercise, and sharp decreases in weight trajectories had negative contribution coefficients of --0.021, --0.032, --0.015, and --0.066, respectively. For time-fixed variables, being male had a contribution coefficient of --0.091. Conclusions: An interpretable algorithm, with both time-variant and time-fixed data, was used to precisely predict weight loss while preserving model transparency. This week-to-week prediction model is expected to improve weight loss and provide a global explanation of contributing factors, leading to better outcomes. ",
doi="10.2196/22183",
url="https://mhealth.jmir.org/2021/3/e22183",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779574"
}


@Article{info:doi/10.2196/22541,
author="Tate, Allan
and Trofholz, Amanda
and Miner, Michael
and Berge, Jerica",
title="Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Mar",
day="24",
volume="4",
number="1",
pages="e22541",
keywords="meal healthfulness",
keywords="direct observation",
keywords="family meals",
keywords="well-being",
keywords="diet",
keywords="food",
abstract="Background: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis--St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50\%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). Conclusions: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment. ",
doi="10.2196/22541",
url="https://pediatrics.jmir.org/2021/1/e22541",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759788"
}


@Article{info:doi/10.2196/23533,
author="Chatterjee, Ayan
and Gerdes, Martin
and Prinz, Andreas
and Martinez, Santiago",
title="Human Coaching Methodologies for Automatic Electronic Coaching (eCoaching) as Behavioral Interventions With Information and Communication Technology: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="24",
volume="23",
number="3",
pages="e23533",
keywords="coaching",
keywords="electronic coaching",
keywords="human behavior",
keywords="healthy lifestyle",
keywords="persuasive technology",
abstract="Background: We systematically reviewed the literature on human coaching to identify different coaching processes as behavioral interventions and methods within those processes. We then reviewed how those identified coaching processes and the used methods can be utilized to improve an electronic coaching (eCoaching) process for the promotion of a healthy lifestyle with the support of information and communication technology (ICT). Objective: This study aimed to identify coaching and eCoaching processes as behavioral interventions and the methods behind these processes. Here, we mainly looked at processes (and corresponding models that describe coaching as certain processes) and the methods that were used within the different processes. Several methods will be part of multiple processes. Certain processes (or the corresponding models) will be applicable for both human coaching and eCoaching. Methods: We performed a systematic literature review to search the scientific databases EBSCOhost, Scopus, ACM, Nature, SpringerLink, IEEE Xplore, MDPI, Google Scholar, and PubMed for publications that included personal coaching (from 2000 to 2019) and persuasive eCoaching as behavioral interventions for a healthy lifestyle (from 2014 to 2019). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was used for the evidence-based systematic review and meta-analysis. Results: The systematic search resulted in 79 publications, including 72 papers and seven books. Of these, 53 were related to behavioral interventions by eCoaching and the remaining 26 were related to human coaching. The most utilized persuasive eCoaching methods were personalization (n=19), interaction and cocreation (n=17), technology adoption for behavior change (n= 17), goal setting and evaluation (n=16), persuasion (n=15), automation (n=14), and lifestyle change (n=14). The most relevant methods for human coaching were behavior (n=23), methodology (n=10), psychology (n=9), and mentoring (n=6). Here, ``n'' signifies the total number of articles where the respective method was identified. In this study, we focused on different coaching methods to understand the psychology, behavioral science, coaching philosophy, and essential coaching processes for effective coaching. We have discussed how we can integrate the obtained knowledge into the eCoaching process for healthy lifestyle management using ICT. We identified that knowledge, coaching skills, observation, interaction, ethics, trust, efficacy study, coaching experience, pragmatism, intervention, goal setting, and evaluation of coaching processes are relevant for eCoaching. Conclusions: This systematic literature review selected processes, associated methods, strengths, and limitations for behavioral interventions from established coaching models. The identified methods of coaching point toward integrating human psychology in eCoaching to develop effective intervention plans for healthy lifestyle management and overcome the existing limitations of human coaching. ",
doi="10.2196/23533",
url="https://www.jmir.org/2021/3/e23533",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759793"
}


@Article{info:doi/10.2196/21116,
author="McDiarmid, Sarah
and Harvie, Michelle
and Johnson, Rhona
and Vyas, Avni
and Aglan, Azza
and Moran, Jacqui
and Ruane, Helen
and Hulme, Amanda
and Sellers, Katharine
and Issa, Basil",
title="Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="19",
volume="10",
number="3",
pages="e21116",
keywords="type 2 diabetes",
keywords="diabetes",
keywords="diabetic diet",
keywords="low-energy diet",
keywords="low calorie diet",
keywords="intermittent energy restriction",
keywords="intermittent fasting",
keywords="diabetes remission",
keywords="smartphone",
keywords="mobile phone",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence. Objective: This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D. Methods: A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention. Results: A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021. Conclusions: The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285 International Registered Report Identifier (IRRID): DERR1-10.2196/21116 ",
doi="10.2196/21116",
url="https://www.researchprotocols.org/2021/3/e21116",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739297"
}


@Article{info:doi/10.2196/22147,
author="Lim, Karen
and Chan, Shiao-Yng
and Lim, Lin Su
and Tai, Choo Bee
and Tsai, Cammy
and Wong, Ren Su
and Ang, Min Siew
and Yew, Wei Tong
and Tai, Shyong E.
and Yong, Leong Eu",
title="A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="16",
volume="9",
number="3",
pages="e22147",
keywords="randomized controlled trial",
keywords="gestational diabetes mellitus",
keywords="prevention",
keywords="weight loss",
keywords="mobile phone",
abstract="Background: Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. Objective: This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. Methods: In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI?23 kg/m2 or weight loss of at least 5\% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. Results: In total, 40\% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32\% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8\% (SD 33.9\%). Conclusions: Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. Trial Registration: ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7691-3 ",
doi="10.2196/22147",
url="https://mhealth.jmir.org/2021/3/e22147",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724204"
}


@Article{info:doi/10.2196/25202,
author="Martino, Florentine
and Brooks, Ruby
and Browne, Jennifer
and Carah, Nicholas
and Zorbas, Christina
and Corben, Kirstan
and Saleeba, Emma
and Martin, Jane
and Peeters, Anna
and Backholer, Kathryn",
title="The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Mar",
day="12",
volume="7",
number="3",
pages="e25202",
keywords="alcohol",
keywords="food and beverage",
keywords="COVID-19",
keywords="marketing",
keywords="social media",
abstract="Background: Emerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and ``comfort eating'' as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how ``Big Food'' and ``Big Alcohol'' are capitalizing on the COVID-19 pandemic to market their products and brands. Objective: We aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia. Methods: We conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia. Results: Nearly 80\% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice. Conclusions: This is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. ``COVID-washing'' by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to ``build back better'' in a post-COVID-19 world. ",
doi="10.2196/25202",
url="https://publichealth.jmir.org/2021/3/e25202",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709935"
}


@Article{info:doi/10.2196/26091,
author="Sandborg, Johanna
and S{\"o}derstr{\"o}m, Emmie
and Henriksson, Pontus
and Bendtsen, Marcus
and Henstr{\"o}m, Maria
and Lepp{\"a}nen, H. Marja
and Maddison, Ralph
and Migueles, H. Jairo
and Blomberg, Marie
and L{\"o}f, Marie",
title="Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="11",
volume="9",
number="3",
pages="e26091",
keywords="gestational weight gain",
keywords="physical activity",
keywords="diet",
keywords="pregnancy",
keywords="mHealth",
keywords="smartphone app",
keywords="mobile phone app",
keywords="telemedicine",
keywords="randomized controlled trial",
abstract="Background: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in {\"O}sterg{\"o}tland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Link{\"o}ping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (--1.33 kg; 95\% CI --2.92 to 0.26; P=.10) and completers-only analyses (--1.67 kg; 95\% CI --3.26 to --0.09; P=.031]). Bayesian analyses showed that there was a 99\% probability of any intervention effect on GWG among women with overweight and obesity, and an 81\% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95\% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P?.21). Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 ",
doi="10.2196/26091",
url="https://mhealth.jmir.org/2021/3/e26091",
url="http://www.ncbi.nlm.nih.gov/pubmed/33704075"
}


@Article{info:doi/10.2196/24534,
author="Trottier, F. Claire
and Lieffers, L. Jessica R.
and Johnson, T. Steven
and Mota, F. Jo{\~a}o
and Gill, K. Roshni
and Prado, M. Carla",
title="The Impact of a Web-Based Mindfulness, Nutrition, and Physical Activity Platform on the Health Status of First-Year University Students: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="10",
volume="10",
number="3",
pages="e24534",
keywords="internet-based intervention",
keywords="wellness programs",
keywords="dietary intake",
keywords="physical activity",
keywords="mindfulness",
keywords="quality of life",
keywords="randomized controlled trial",
abstract="Background: First-year university students are at an increased risk for developing mental health issues and a poor nutritional status. Self-care plays an essential role in optimizing mental health and can prevent or manage stress, anxiety, and depression. Web-based self-monitoring of diet and physical activity can lead to similar or improved health outcomes compared with conventional methods. Such tools are also popular among university students. Objective: The primary aim of this 12-week randomized controlled trial is to assess the impact of a web-based wellness platform on perceived stress among first-year university students. The secondary aim is to assess the effects of the platform on diet quality. The exploratory objectives are to explore the effects of the platform on body composition, health-related quality of life, mindfulness, mental well-being, and physical activity. Methods: A total of 97 first-year undergraduate students were randomized to either the intervention (n=48) or control (n=49) group. The intervention consisted of access to a web-based platform called My Viva Plan (MVP), which aims to support healthy living by focusing on the topics of mindfulness, nutrition, and physical activity. The platform is fully automated and guided by the principles of cognitive behavioral theory. Participants in the intervention group were instructed to use the MVP as frequently as possible over 12 weeks. The control group did not receive access to MVP. Perceived stress was assessed using the Stress Indicators Questionnaire at baseline, week 6, and week 12. Three-day food records were used to analyze the dietary intake at baseline and week 12. Health-related quality of life, mindfulness, mental well-being, and physical activity questionnaires were completed at baseline, week 6, and week 12. Body composition was assessed at baseline and week 12. Study assessments were completed in person at baseline and week 12 and electronically at week 6. Results: Study recruitment started in August 2018, with batch enrollment for students registered in the fall (September 2018 to December 2018) and winter (January 2019 to April 2019) academic terms at the University of Alberta, Edmonton, Alberta. Conclusions: This study is the first to explore the impact of a web-based platform designed to promote health and wellness on perceived stress and diet quality among first-year university students. Trial Registration: ClinicalTrials.gov NCT03579264; https://clinicaltrials.gov/ct2/show/NCT03579264. International Registered Report Identifier (IRRID): DERR1-10.2196/24534 ",
doi="10.2196/24534",
url="https://www.researchprotocols.org/2021/3/e24534",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688844"
}


@Article{info:doi/10.2196/26159,
author="Sandborg, Johanna
and Henriksson, Pontus
and Larsen, Erica
and Lindqvist, Anna-Karin
and Rutberg, Stina
and S{\"o}derstr{\"o}m, Emmie
and Maddison, Ralph
and L{\"o}f, Marie",
title="Participants' Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="5",
volume="9",
number="3",
pages="e26159",
keywords="pregnancy",
keywords="gestational weight gain",
keywords="mHealth",
keywords="telemedicine",
keywords="digital health",
keywords="mobile health",
keywords="eHealth",
keywords="smartphone intervention",
keywords="mobile application",
keywords="smartphone application",
keywords="engagement",
keywords="physical activity",
keywords="exercise",
keywords="nutrition",
keywords="diet",
keywords="qualitative",
keywords="thematic analysis",
abstract="Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health--delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users' experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants' engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68\%; primiparous: 11/19, 58\%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, ``One could suit many: a multifunctional tool to strengthen women's health during pregnancy,'' and the 2 subthemes, ``Factors within and beyond the app influence app engagement'' and ``Trust, knowledge, and awareness: aspects that can motivate healthy habits,'' illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 ",
doi="10.2196/26159",
url="https://mhealth.jmir.org/2021/3/e26159",
url="http://www.ncbi.nlm.nih.gov/pubmed/33666554"
}


@Article{info:doi/10.2196/13591,
author="Alawadhi, Balqees
and Fallaize, Rosalind
and Franco, Zenun Rodrigo
and Hwang, Faustina
and Lovegrove, Julie",
title="Web-Based Dietary Intake Estimation to Assess the Reproducibility and Relative Validity of the EatWellQ8 Food Frequency Questionnaire: Validation Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="2",
volume="5",
number="3",
pages="e13591",
keywords="web-based",
keywords="Kuwait",
keywords="weighed food record",
keywords="app",
keywords="food frequency questionnaire",
keywords="validation",
keywords="dietary assessment",
abstract="Background: The web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Validation against reliable instruments and assessment of its reproducibility are required to ensure the accuracy of the EatWellQ8 FFQ in computing nutrient intake. Objective: This study aims to assess the reproducibility and relative validity of the EatWellQ8 146-item FFQ, which included images of food portion sizes based on The Composition of Foods by McCance and Widdowson and food composition tables from Kuwait and the Kingdom of Bahrain, against a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR). Methods: Reproducibility of the EatWellQ8 FFQ was assessed using a test-retest methodology. Participants were required to complete the FFQ at 2 time points, 4 weeks apart. To assess the relative validity of the EatWellQ8 FFQ, a subset of the participants were asked to complete a PFFQ or a 4-day WFR 1 week after the administration of the EatWellQ8 FFQ. The level of agreement between nutrient and food group intakes was estimated by repeated EatWellQ8 FFQ administration. The EatWellQ8 FFQ, PFFQ, and 4-day WFR were also evaluated using the Bland-Altman methodology and classified into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrients and food groups. Results: A total of 99 Kuwaiti participants (64/99, 65\% female and 35/99, 35\% male) completed the study---53 participated in the reproducibility study and the 4-day WFR validity study (mean age 37.1 years, SD 9.9) and 46 participated in the PFFQ validity study (mean age 36.2 years, SD 8.3). Crude unadjusted correlations for repeated EatWellQ8 FFQs ranged from 0.37 to 0.93 (mean r=0.67, SD 0.14; 95\% CI 0.11-0.95) for nutrients and food groups (P=.01). Mean cross-classification into exact agreement plus adjacent was 88\% for nutrient intakes and 86\% for food groups, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. The association between the EatWellQ8 FFQ and PFFQ varied, with crude unadjusted correlations ranging from 0.42 to 0.73 (mean r=0.46, SD 0.12; 95\% CI ?0.02 to 0.84; P=.046). Mean cross-classification into exact agreement plus adjacent was 84\% for nutrient intake and 74\% for food groups. Bland-Altman plots showed moderate agreement for both energy and energy-controlled nutrient intakes. Crude unadjusted correlations for the EatWellQ8 FFQ and the 4-day WFR ranged from 0.40 to 0.88 (mean r=0.58, SD 0.13; 95\% CI 0.01-0.58; P=.01). Mean cross-classification into exact agreement plus adjacent was 85\% for nutrient intake and 83\% for food groups. Bland-Altman plots showed moderate agreement for energy-adjusted macronutrient intakes. Conclusions: The results indicate that the web-based EatWellQ8 FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a PFFQ and a 4-day WFR for measuring energy and nutrient intakes. ",
doi="10.2196/13591",
url="https://formative.jmir.org/2021/3/e13591",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650974"
}


@Article{info:doi/10.2196/19239,
author="Chang, Leanne
and Chattopadhyay, Kaushik
and Li, Jialin
and Xu, Miao
and Li, Li",
title="Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="1",
volume="9",
number="3",
pages="e19239",
keywords="obesity",
keywords="social comparison",
keywords="social media",
keywords="social support",
keywords="surveillance",
keywords="weight control",
abstract="Background: There has been a significant increase in the trend of using social media as a platform to deliver weight management interventions. This illustrates a need to develop a holistic understanding of doctor-patient communication and peer-to-peer communication in social media interventions and to determine their influences on weight management for people with overweight or obesity. Such studies will highlight how social media can be more effectively integrated into weight management programs to enhance individuals' short-term and long-term weight management behaviors. Objective: The aim of this study was to examine patients' experiences with doctor-patient communication and peer interactions in a social media--based (WeChat) weight management program, and to describe the interplay of three social influence factors---social support, social comparison, and surveillance---in their weight control practices. The program, designed and implemented by the research team located in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components that targeted people with overweight or obesity. Methods: We conducted in-depth interviews with 32 program participants of different ages (mean  35.6, SD 7.7 years), gender (18 women), duration of program membership (mean 1.4 years), and weight loss outcomes (54\% weight loss to 9\% weight gain). All interview data were audio-recorded, transcribed, and translated using the translation-backtranslation technique. Nvivo software was used to facilitate the coding process. Results: Results of thematic analysis indicated the distinct functions of professionally led support and peer support. Professional support was presented in the form of knowledge infusion, efficacy enhancement, and provision of timely feedback. Peer support fostered empathy and sense of belonging, and had a mutually reinforcing relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it also reinforced negative group norms, and resulted in downturns in reference standards and collective inactivity. Social media surveillance prompted participants' reactions to the gaze from medical professionals and peers that could be encouraging or inhibiting. Surveillance enhanced vigilance with weight control norms; however, its influence weakened when participants chose to fake weight data and turn off notifications. Findings from this study illustrated the interrelated and fluctuating influences of support, comparison, and surveillance. Conclusions: The interactive traits of social media eased the practices of social support and social comparison, and created new forms of surveillance. This study contributes to an in-depth understanding of social media influences on individuals' weight control behaviors. Practical implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025861; http://www.chictr.org.cn/showprojen.aspx?proj=42497 ",
doi="10.2196/19239",
url="https://mhealth.jmir.org/2021/3/e19239",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646130"
}


@Article{info:doi/10.2196/23786,
author="Duan, Yanping
and Shang, Borui
and Liang, Wei
and Du, Gaohui
and Yang, Min
and Rhodes, E. Ryan",
title="Effects of eHealth-Based Multiple Health Behavior Change Interventions on Physical Activity, Healthy Diet, and Weight in People With Noncommunicable Diseases: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="22",
volume="23",
number="2",
pages="e23786",
keywords="systematic review",
keywords="meta-analysis",
keywords="noncommunicable disease",
keywords="multiple health behavior change",
keywords="weight-related",
keywords="physical activity",
keywords="healthy diet",
keywords="eHealth",
abstract="Background: Noncommunicable diseases (NCDs) are associated with the burden of premature deaths and huge medical costs globally. There is an increasing number of studies combining a multiple health behavior change (MHBC) intervention paradigm with eHealth approaches to jointly promote weight-related health behaviors among people with NCD; yet, a comprehensive summary of these studies is lacking. Objective: This review aims to meta-analyze the effectiveness and systematically summarize the characteristics of the relevant intervention studies for improving the outcomes of physical activity, healthy diet, and weight among people with NCD. Methods: Following PRISMA guidelines, 4 electronic databases (PsycINFO, PubMed, Scopus, SPORTDiscus) were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. Article selection, quality assessment, and data extraction were independently performed by 2 authors. The standardized mean difference (SMD) was calculated to evaluate the effectiveness of interventions for 3 intervention outcomes (physical activity, healthy diet, and weight), and subsequent subgroup analyses were performed for gender, age, intervention duration, channel, and theory. Calculations were conducted, and figures were produced in SPSS 22 and Review Manager 5.3. Results: Of the 664 original hits generated by the systematic searches, 15 eligible studies with moderate to high quality were included. No potential publication bias was detected using statistical analyses. Studies varied in intervention channel, intensity, and content. The meta-analysis revealed that the eHealth MHBC interventions significantly promoted physical activity (SMD 0.85, 95\% CI 0.23 to 1.47, P=.008) and healthy diet (SMD 0.78, 95\% CI 0.13 to 1.43, P=.02), but did not contribute to a healthy weight status (SMD --0.13, 95\% CI= --0.47 to 0.20, P=.43) among people with NCDs, compared to the control conditions. Results from subgroup analysis indicated that theory-based interventions achieved greater effect than nontheory-based interventions in promoting physical activity, and interventions with traditional approaches (SMS, telephone) were more effective than those with modern internet-based approaches in promoting healthy diet. Conclusions: The results of this review indicates that eHealth MHBC interventions achieve preliminary success in promoting physical activity and healthy diet behaviors among people with NCD. Future studies could improve the intervention design to achieve better intervention effectiveness. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019118629; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=118629 ",
doi="10.2196/23786",
url="https://www.jmir.org/2021/2/e23786",
url="http://www.ncbi.nlm.nih.gov/pubmed/33616534"
}


@Article{info:doi/10.2196/20217,
author="Benavides, Carmen
and Ben{\'i}tez-Andrades, Alberto Jos{\'e}
and Marqu{\'e}s-S{\'a}nchez, Pilar
and Arias, Natalia",
title="eHealth Intervention to Improve Health Habits in the Adolescent Population: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="18",
volume="9",
number="2",
pages="e20217",
keywords="adolescent behaviors",
keywords="BMI",
keywords="diet",
keywords="healthy habits",
keywords="intervention",
keywords="leader",
keywords="physical activity",
keywords="social network analysis",
keywords="adolescent",
keywords="social network",
keywords="behavior",
abstract="Background: Technology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents. Objective: The purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app. Methods: The BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants' diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the ``degree'' measure, which was used as an indicative parameter of centrality. Results: The sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1\% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app. Conclusions: The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity. ",
doi="10.2196/20217",
url="http://mhealth.jmir.org/2021/2/e20217/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599616"
}


@Article{info:doi/10.2196/14760,
author="Jung, Hyunggu
and Demiris, George
and Tarczy-Hornoch, Peter
and Zachry, Mark",
title="A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="17",
volume="5",
number="2",
pages="e14760",
keywords="mobile health",
keywords="older adults",
keywords="diabetes",
keywords="dietary assessment",
keywords="smartphone app",
keywords="usability test",
abstract="Background: More than 1 in 4 people in the United States aged 65 years and older have type 2 diabetes. For diabetes care, medical nutrition therapy is recommended as a clinically effective intervention. Previous researchers have developed and validated dietary assessment methods using images of food items to improve the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. Objective: The aims of this study were (1) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and (2) to evaluate the usability of FRADA for older adults with diabetes. Methods: For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on the design principles. For the usability assessment of FRADA, older adults aged 65 to 80 years (11 females and 3 males) were assigned to interact with FRADA in a lab-based setting. Participants' opinions of FRADA and its usability were determined by a follow-up survey and interview. As an evaluation indicator of usability, the responses to the survey, including an after-scenario questionnaire, were analyzed. Qualitative data from the interviews confirmed the responses to the survey. Results: We developed a smartphone app that enables older adults with diabetes to capture, view, and transmit images of food items they consumed. The findings of this study showed that FRADA and its instructions for capturing, viewing, and transmitting images of food items were usable for older adults with diabetes. The survey showed that participants found FRADA easy to use and would consider using FRADA daily. The analysis of the qualitative data from interviews revealed multiple categories, such as the usability of FRADA, potential benefits of using FRADA, potential features to be added to FRADA, and concerns of older adults with diabetes regarding interactions with FRADA. Conclusions: This study demonstrates in a lab-based setting not only the usability of FRADA by older adults with diabetes but also potential opportunities using FRADA in real-world settings. The findings suggest implications for creating a smartphone app for an image-assisted dietary assessment. Future work still remains to evaluate the feasibility and validity of FRADA with multiple stakeholders, including older adults with diabetes and dietitians. ",
doi="10.2196/14760",
url="http://formative.jmir.org/2021/2/e14760/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33493129"
}


@Article{info:doi/10.2196/18311,
author="R{\o}ed, Margrethe
and Medin, C. Anine
and Vik, N. Fr{\o}ydis
and Hillesund, R. Elisabet
and Van Lippevelde, Wendy
and Campbell, Karen
and {\O}verby, C. Nina",
title="Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="16",
volume="23",
number="2",
pages="e18311",
keywords="toddler",
keywords="child",
keywords="eHealth",
keywords="intervention",
keywords="randomized controlled trial",
keywords="fruit",
keywords="vegetable",
keywords="discretionary food",
abstract="Background: In Western countries, children's diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family's diet. Objective: In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers' diets by shaping their food and eating environment. Methods: The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7\%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time {\texttimes} group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results: At follow-up 1, a significant time {\texttimes} group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95\% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed.  However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions: A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420 ",
doi="10.2196/18311",
url="http://www.jmir.org/2021/2/e18311/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591279"
}


@Article{info:doi/10.2196/19430,
author="Sun, Yuewen
and Luo, Rong
and Li, Yuan
and He, J. Feng
and Tan, Monique
and MacGregor, A. Graham
and Liu, Hueiming
and Zhang, Puhong",
title="App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="10",
volume="10",
number="2",
pages="e19430",
keywords="mobile health",
keywords="mobile phone",
keywords="process evaluation",
keywords="salt reduction",
keywords="health education",
abstract="Background: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/19430 ",
doi="10.2196/19430",
url="http://www.researchprotocols.org/2021/2/e19430/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33565991"
}


@Article{info:doi/10.2196/23796,
author="Markert, Carl
and Sasangohar, Farzan
and Mortazavi, J. Bobak
and Fields, Sherecce",
title="The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review",
journal="JMIR Hum Factors",
year="2021",
month="Jan",
day="29",
volume="8",
number="1",
pages="e23796",
keywords="telemedicine",
keywords="remote sensing technology",
keywords="health coaching",
keywords="decision support systems",
keywords="clinical",
keywords="older adults",
abstract="Background: Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. Objective: This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). Methods: A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. Results: Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. Conclusions: Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching. ",
doi="10.2196/23796",
url="http://humanfactors.jmir.org/2021/1/e23796/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33512322"
}


@Article{info:doi/10.2196/17501,
author="Carlin, Angela
and Logue, Caomhan
and Flynn, Jonathan
and Murphy, H. Marie
and Gallagher, M. Alison",
title="Development and Feasibility of a Family-Based Health Behavior Intervention Using Intelligent Personal Assistants: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="28",
volume="5",
number="1",
pages="e17501",
keywords="children",
keywords="parent",
keywords="physical activity",
keywords="healthy eating",
keywords="technology",
keywords="mobile phone",
abstract="Background: Intelligent personal assistants such as Amazon Echo and Google Home have become increasingly integrated into the home setting and, therefore, may facilitate behavior change via novel interactions or as an adjunct to conventional interventions. However, little is currently known about their potential role in this context. Objective: This feasibility study aims to develop the Intelligent Personal Assistant Project (IPAP) and assess the acceptability and feasibility of this technology for promoting and maintaining physical activity and other health-related behaviors in both parents and children. Methods: This pilot feasibility study was conducted in 2 phases. For phase 1, families who were attending a community-based weight management project were invited to participate, whereas phase 2 recruited families not currently receiving any additional intervention. Families were randomly allocated to either the intervention group (received a smart speaker for use in the family home) or the control group. The IPAP intervention aimed to promote positive health behaviors in the family setting through utilization of the functions of a smart speaker and its linked intelligent personal assistant. Data were collected on recruitment, retention, outcome measures, intervention acceptability, device interactions, and usage. Results: In total, 26 families with at least one child aged 5 to 12 years were recruited, with 23 families retained at follow-up. Across phase 1 of the intervention, families interacted with the intelligent personal assistant a total of 65 times. Although device interactions across phase 2 of the intervention were much higher (312 times), only 10.9\% (34/312) of interactions were coded as relevant (related to diet, physical activity or well-being). Focus groups highlighted that the families found the devices acceptable and easy to use and felt that the prompts or reminders were useful in prompting healthier behaviors. Some further intervention refinements in relation to the timing of prompts and integrating feedback alongside the devices were suggested by families. Conclusions: Using intelligent personal assistants to deliver health-related messages and information within the home is feasible, with high levels of engagement reported by participating families. This novel feasibility study highlights important methodological considerations that should inform future trials testing the effectiveness of intelligent personal assistants in promoting positive health-related behaviors. Trial Registration: ISRCTN Registry ISRCTN16792534; http://www.isrctn.com/ISRCTN16792534 ",
doi="10.2196/17501",
url="http://formative.jmir.org/2021/1/e17501/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33507155"
}


@Article{info:doi/10.2196/22680,
author="Balestrin, Mariana
and Brasil, Bauermann Carla Cristina
and Bellei, Andrei Ericles
and Kirsten, Ramos Vanessa
and Wagner, Bernardes Mario",
title="Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="19",
volume="10",
number="1",
pages="e22680",
keywords="school health services",
keywords="healthy diet",
keywords="pediatric obesity",
keywords="schools",
keywords="snacks",
abstract="Background: School cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings. Objective: We aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil. Methods: We will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95\% CI. Results: This project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021. Conclusions: To our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals. Trial Registration: Brazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhk International Registered Report Identifier (IRRID): DERR1-10.2196/22680 ",
doi="10.2196/22680",
url="http://www.researchprotocols.org/2021/1/e22680/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464219"
}


@Article{info:doi/10.2196/20491,
author="Hallsworth, Kate
and McPherson, Stuart
and Anstee, M. Quentin
and Flynn, Darren
and Haigh, Laura
and Avery, Leah",
title="Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="15",
volume="23",
number="1",
pages="e20491",
keywords="nonalcoholic fatty liver disease",
keywords="internet-based intervention",
keywords="lifestyle",
keywords="diet",
keywords="physical activity",
keywords="weight loss",
abstract="Background: Nonalcoholic fatty liver disease (NAFLD) is linked to excessive calorie consumption, physical inactivity, and being overweight. Patients with NAFLD can halt or decelerate progression and potentially reverse their condition by changing their lifestyle behavior. International guidelines recommend the use of lifestyle interventions; however, there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific interventions to support weight loss and improve liver function. Objective: This study aims to use intervention mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes in their dietary and physical activity behavior to promote weight loss. Methods: Intervention mapping consisted of 6 steps: step 1 involved a needs assessment with primary and secondary health care professionals (HCPs) and patients with NAFLD; step 2 involved identification of the social cognitive determinants of change and behavioral outcomes of the intervention; step 3 involved linking social cognitive determinants of behavioral outcomes with behavior change techniques to effectively target dietary and physical activity behavior; step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content was identified as important for improving knowledge and skills from steps 1 and 2; step 5 involved the development of an implementation plan with a digital provider of lifestyle behavior change programs to patients with NAFLD using their delivery platform and lifestyle coaches; and step 6 involved piloting the digital intervention with patients to obtain data on access, usability, and content. Results: A digital intervention was developed, consisting of 8 modules; self-regulatory tools; and provision of telephone support by trained lifestyle coaches to help facilitate behavioral intention, enactment, and maintenance. A commercial provider of digital lifestyle behavior change programs enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. A total of 11 of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average 4 times over the piloting period). The most frequently accessed modules were welcome to the program, understanding NAFLD, and food and NAFLD. Goal setting and self-monitoring tools were accessed on 22 occasions (4 times per tool on average). A total of 3 out of 11 participants requested access to a lifestyle coach. Conclusions: Intervention mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process for patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimization of information content, and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness. ",
doi="10.2196/20491",
url="http://www.jmir.org/2021/1/e20491/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33448929"
}


@Article{info:doi/10.2196/24714,
author="Staiano, E. Amanda
and Shanley, R. Jenelle
and Kihm, Holly
and Hawkins, R. Keely
and Self-Brown, Shannon
and H{\"o}chsmann, Christoph
and Osborne, C. Melissa
and LeBlanc, M. Monique
and Apolzan, W. John
and Martin, K. Corby",
title="Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="7",
volume="4",
number="1",
pages="e24714",
keywords="parent training",
keywords="weight loss",
keywords="telehealth",
keywords="obesity",
keywords="SafeCare",
abstract="Background: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the ``mHealth DRIVE'' program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. Objective: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. Methods: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. Results: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children's (N=10) BMI z-scores significantly decreased (mean --0.14, SD 0.17; P=.025). Over 90\% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80\% of providers reported that they and the families would benefit from digital tools to support child weight management. Conclusions: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. Trial Registration: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541. ",
doi="10.2196/24714",
url="https://pediatrics.jmir.org/2021/1/e24714",
url="http://www.ncbi.nlm.nih.gov/pubmed/33410760"
}


@Article{info:doi/10.2196/22184,
author="Kwon, Hongwook
and Kim, Heon Ho
and An, Jaeil
and Lee, Jae-Ho
and Park, Rang Yu",
title="Lifelog Data-Based Prediction Model of Digital Health Care App Customer Churn: Retrospective Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="6",
volume="23",
number="1",
pages="e22184",
keywords="churn prediction",
keywords="digital health care",
keywords="life-log data",
keywords="topic modeling",
keywords="recurrent neural network",
keywords="deep learning interpretation",
keywords="attribution method",
keywords="integrated gradients",
keywords="digital health",
keywords="prediction",
keywords="model",
keywords="data",
keywords="app",
keywords="observational",
keywords="time-series",
keywords="neural network",
abstract="Background: Customer churn is the rate at which customers stop doing business with an entity. In the field of digital health care, user churn prediction is important not only in terms of company revenue but also for improving the health of users. Churn prediction has been previously studied, but most studies applied time-invariant model structures and used structured data. However, additional unstructured data have become available; therefore, it has become essential to process daily time-series log data for churn predictions. Objective: We aimed to apply a recurrent neural network structure to accept time-series patterns using lifelog data and text message data to predict the churn of digital health care users. Methods: This study was based on the use data of a digital health care app that provides interactive messages with human coaches regarding food, exercise, and weight logs. Among the users in Korea who enrolled between January 1, 2017 and January 1, 2019, we defined churn users according to the following criteria: users who received a refund before the paid program ended and users who received a refund 7 days after the trial period. We used long short-term memory with a masking layer to receive sequence data with different lengths. We also performed topic modeling to vectorize text messages. To interpret the contributions of each variable to model predictions, we used integrated gradients, which is an attribution method. Results: A total of 1868 eligible users were included in this study. The final performance of churn prediction was an F1 score of 0.89; that score decreased by 0.12 when the data of the final week were excluded (F1 score 0.77). Additionally, when text data were included, the mean predicted performance increased by approximately 0.085 at every time point. Steps per day had the largest contribution (0.1085). Among the topic variables, poor habits (eg, drinking alcohol, overeating, and late-night eating) showed the largest contribution (0.0875). Conclusions: The model with a recurrent neural network architecture that used log data and message data demonstrated high performance for churn classification. Additionally, the analysis of the contribution of the  variables is expected to help identify signs of user churn in advance and improve the adherence in digital health care. ",
doi="10.2196/22184",
url="https://www.jmir.org/2021/1/e22184",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404511"
}


@Article{info:doi/10.2196/19737,
author="Atorkey, Prince
and Paul, Christine
and Bonevski, Billie
and Wiggers, John
and Mitchell, Aimee
and Byrnes, Emma
and Lecathelinais, Christophe
and Tzelepis, Flora",
title="Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="6",
volume="23",
number="1",
pages="e19737",
keywords="uptake",
keywords="proactive offer",
keywords="online support services",
keywords="telephone support services",
keywords="multiple health risk behaviors",
keywords="vocational education students",
abstract="Background: A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. Objective: The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. Methods: Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. Results: Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3\% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5\% (59/406) for fruit and vegetables, 12.7\% (29/228) for physical activity, 6.8\% (13/191) for smoking, and 5.5\% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8\% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95\% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95\% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95\% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95\% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95\% CI 0.06-0.56) of signing up for support services for at least two behaviors. Conclusions: Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001. ",
doi="10.2196/19737",
url="https://www.jmir.org/2021/1/e19737",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404504"
}


@Article{info:doi/10.2196/22186,
author="Kramer, L. Lean
and Mulder, C. Bob
and van Velsen, Lex
and de Vet, Emely",
title="Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="6",
volume="10",
number="1",
pages="e22186",
keywords="embodied conversational agent",
keywords="health behavior change",
keywords="loneliness",
keywords="eating behavior",
keywords="older adults",
abstract="Background: An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner. Objective: We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA. Methods: The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome---use---will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview. Results: As of July 2020, we have begun recruiting participants. Conclusions: By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context. Trial Registration: ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883 International Registered Report Identifier (IRRID): PRR1-10.2196/22186 ",
doi="10.2196/22186",
url="https://www.researchprotocols.org/2021/1/e22186",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404513"
}


@Article{info:doi/10.2196/19238,
author="Chan, M. June
and Van Blarigan, L. Erin
and Langlais, S. Crystal
and Zhao, Shoujun
and Ramsdill, W. Justin
and Daniel, Kimi
and Macaire, Greta
and Wang, Elizabeth
and Paich, Kellie
and Kessler, R. Elizabeth
and Beer, M. Tomasz
and Lyons, S. Karen
and Broering, M. Jeanette
and Carroll, R. Peter
and Kenfield, A. Stacey
and Winters-Stone, M. Kerri",
title="Feasibility and Acceptability of a Remotely Delivered, Web-Based Behavioral Intervention for Men With Prostate Cancer: Four-Arm Randomized Controlled Pilot Trial",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="31",
volume="22",
number="12",
pages="e19238",
keywords="diet",
keywords="physical activity",
keywords="exercise",
keywords="lifestyle",
keywords="cancer",
keywords="survivorship",
keywords="text messages",
keywords="internet",
abstract="Background: Diet and exercise may be associated with quality of life and survival in men with prostate cancer. Objective: This study aimed to determine the feasibility and acceptability of a remotely delivered web-based behavioral intervention among men with prostate cancer. Methods: We conducted a multi-site 4-arm pilot randomized controlled trial of a 3-month intervention (TrueNTH Community of Wellness). Eligibility included self-reported prostate cancer diagnosis, having a personal device that connected to the internet, age ?18 years, and ability to read English and receive text messages and emails. Men receiving chemotherapy or radiation, or those who reported contraindications to exercise, could participate with physician clearance. Participants were randomized (1:1:1:1) to additive intervention levels: website; website and personalized diet and exercise prescription; website, personalized prescription, Fitbit, and text messages; and website, personalized prescription, Fitbit, text messages, and 2 30-minute phone calls---one with an exercise trainer and one with a registered dietician. Primary outcomes were feasibility (accrual and attrition) and acceptability (survey data and website use). We described self-reported diet and exercise behavior at the time of enrollment, 3 months, and 6 months as secondary outcomes. Results: In total, 202 men consented and were randomized between August 2017 and September 2018 (level 1: 49, level 2: 51, level 3: 50, level 4: 52). A total of 160 men completed the onboarding process and were exposed to their randomly assigned intervention (38, 38, 42, and 42 in levels 1, 2, 3, and 4, respectively). The follow-up rate was 82.7\% (167/202) at 3 months and 77.2\% (156/202) at 6 months. Participants had a median age of 70 years and were primarily White and college educated. Website visit frequency over the 3-month intervention period increased across levels (median: 2, 9, 11, and 16 visits for levels 1, 2, 3, and 4, respectively). Most were satisfied or very satisfied with the intervention (20/39, 51\%; 27/42, 64\%; 23/44, 52\%; and 27/42, 64\% for levels 1, 2, 3, and 4, respectively). The percentage of men who reported being very satisfied was highest among level 4 participants (10/42, 24\% vs 4/39, 10\%; 5/42, 12\%; and 5/44, 11\% for levels 1, 2, and 3, respectively). Dissatisfaction was highest in level 1 (5/39, 13\% vs 1/42, 2\%; 3/44, 7\%; and 2/42, 5\% for levels 2, 3, and 4, respectively). We observed small improvements in diet and physical activity at 3 months among men in level 4 versus those in level 1. Conclusions: A web-based, remotely delivered, tailored behavioral intervention for men with prostate cancer is feasible. Future studies are warranted to increase the effect of the intervention on patient behavior while maintaining sustainability and scalability as well as to design and implement interventions for more diverse populations. Trial Registration: ClinicalTrials.gov NCT03406013; http://clinicaltrials.gov/ct2/show/NCT03406013 ",
doi="10.2196/19238",
url="http://www.jmir.org/2020/12/e19238/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33382378"
}


@Article{info:doi/10.2196/21602,
author="Locher, Ione
and Waselewski, Marika
and Sonneville, Kendrin
and Resnicow, Ken
and Chang, Tammy",
title="Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="24",
volume="4",
number="12",
pages="e21602",
keywords="pregnancy",
keywords="adolescent",
keywords="young adult",
keywords="female",
keywords="gestational weight gain",
keywords="diet",
keywords="food preferences",
keywords="text messaging",
keywords="feasibility studies",
abstract="Background: Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective: Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods: The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US \$35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants' perspectives on grocery delivery, participants' perspectives on dietary impact of the program, and foods consumed by participants. Results: A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3\% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5\% (259/263) successful deliveries and 89.4\% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions: A grocery delivery--based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy. ",
doi="10.2196/21602",
url="http://formative.jmir.org/2020/12/e21602/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33361055"
}


@Article{info:doi/10.2196/22775,
author="Haileslassie, Abebe Hiwot
and Ramikie, Renee
and Vatanparast, Hassan
and Ramdath, Dan D.
and Froehlich Chow, Amanda
and Shand, Phyllis
and Engler-Stringer, Rachel
and Lieffers, RL Jessica
and Hood-Niefer, Shannon
and Henry, Carol",
title="A Nutrition Intervention to Promote the Consumption of Pulse-Based Foods in Childcare Centers: Protocol for a Multimethod Study",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="24",
volume="9",
number="12",
pages="e22775",
keywords="behavior change",
keywords="childcare center",
keywords="intervention mapping",
keywords="nutrition intervention",
keywords="preschool children",
keywords="pulse",
abstract="Background: Plant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce. Objective: We describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada. Methods: The Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out. Results: The application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere. Conclusions: The IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers. International Registered Report Identifier (IRRID): RR1-10.2196/22775 ",
doi="10.2196/22775",
url="http://www.researchprotocols.org/2020/12/e22775/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33361052"
}


@Article{info:doi/10.2196/21733,
author="Kwon, Chul Bum
and VanDam, Courtland
and Chiuve, E. Stephanie
and Choi, Wook Hyung
and Entler, Paul
and Tan, Pang-Ning
and Huh-Yoo, Jina",
title="Improving Heart Disease Risk Through Quality-Focused Diet Logging: Pre-Post Study of a Diet Quality Tracking App",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="23",
volume="8",
number="12",
pages="e21733",
keywords="mHealth",
keywords="diet monitoring",
keywords="diet tracking",
keywords="food tracking",
keywords="CVD",
keywords="heart disease risk",
keywords="health risk communication",
keywords="human-computer interaction",
keywords="user study",
keywords="mobile phone",
abstract="Background: Diet-tracking mobile apps have gained increased interest from both academic and clinical fields. However, quantity-focused diet tracking (eg, calorie counting) can be time-consuming and tedious, leading to unsustained adoption. Diet quality---focusing on high-quality dietary patterns rather than quantifying diet into calories---has shown effectiveness in improving heart disease risk. The Healthy Heart Score (HHS) predicts 20-year cardiovascular risks based on the consumption of foods from quality-focused food categories, rather than detailed serving sizes. No studies have examined how mobile health (mHealth) apps focusing on diet quality can bring promising results in health outcomes and ease of adoption. Objective: This study aims to design a mobile app to support the HHS-informed quality-focused dietary approach by enabling users to log simplified diet quality and view its real-time impact on future heart disease risks. Users were asked to log food categories that are the main predictors of the HHS. We measured the app's feasibility and efficacy in improving individuals' clinical and behavioral factors that affect future heart disease risks and app use. Methods: We recruited 38 participants who were overweight or obese with high heart disease risk and who used the app for 5 weeks and measured weight, blood sugar, blood pressure, HHS, and diet score (DS)---the measurement for diet quality---at baseline and week 5 of the intervention. Results: Most participants (30/38, 79\%) used the app every week and showed significant improvements in DS (baseline: mean 1.31, SD 1.14; week 5: mean 2.36, SD 2.48; 2-tailed t test t29=?2.85; P=.008) and HHS (baseline: mean 22.94, SD 18.86; week 4: mean 22.15, SD 18.58; t29=2.41; P=.02) at week 5, although only 10 participants (10/38, 26\%) checked their HHS risk scores more than once. Other outcomes, including weight, blood sugar, and blood pressure, did not show significant changes. Conclusions: Our study showed that our logging tool significantly improved dietary choices. Participants were not interested in seeing the HHS and perceived logging diet categories irrelevant to improving the HHS as important. We discuss the complexities of addressing health risks and quantity- versus quality-based health monitoring and incorporating secondary behavior change goals that matter to users when designing mHealth apps. ",
doi="10.2196/21733",
url="http://mhealth.jmir.org/2020/12/e21733/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33355537"
}


@Article{info:doi/10.2196/17814,
author="Foley, Louise
and Francis, Oliver
and Musuva, Rosemary
and Mogo, RI Ebele
and Turner-Moss, Eleanor
and Wadende, Pamela
and Were, Vincent
and Obonyo, Charles",
title="Impacts of a New Supermarket on Dietary Behavior and the Local Foodscape in Kisumu, Kenya: Protocol for a Mixed Methods, Natural Experimental Study",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="21",
volume="9",
number="12",
pages="e17814",
keywords="food retail",
keywords="food environment",
keywords="supermarket",
keywords="natural experiment",
keywords="diet",
keywords="Africa",
abstract="Background: Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation. Objective: The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status. Methods: We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no hypermarket (ie, Homabay). The study is comprised of 4 pieces of primary data collection: a quantitative household survey with local residents, a qualitative study consisting of focus group discussions with local residents and semistructured interviews with government and private sector stakeholders, an audit of the local foodscape using on-the-ground data collection, and an intercept survey of shoppers in the hypermarket. Assessments will be undertaken at baseline and approximately 1 year after the hypermarket opens. Results: Baseline assessments were conducted from March 2019 to June 2019. From a total sampling frame of 400 households, we recruited 376 of these households, giving an overall response rate of 94.0\%. The household survey was completed by 516 individuals within these households. Across the two study areas, 8 focus groups and 44 stakeholder interviews were conducted, and 1920 food outlets were geocoded. Conclusions: This study aims to further the understanding of the relationship between food retail and dietary behaviors in Kenya. Baseline assessments for the study have been completed. International Registered Report Identifier (IRRID): DERR1-10.2196/17814 ",
doi="10.2196/17814",
url="http://www.researchprotocols.org/2020/12/e17814/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33346736"
}


@Article{info:doi/10.2196/20625,
author="Bin Morshed, Mehrab
and Kulkarni, Shreeram Samruddhi
and Li, Richard
and Saha, Koustuv
and Roper, Galante Leah
and Nachman, Lama
and Lu, Hong
and Mirabella, Lucia
and Srivastava, Sanjeev
and De Choudhury, Munmun
and de Barbaro, Kaya
and Ploetz, Thomas
and Abowd, D. Gregory",
title="A Real-Time Eating Detection System for Capturing Eating Moments and Triggering Ecological Momentary Assessments to Obtain Further Context: System Development and Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="18",
volume="8",
number="12",
pages="e20625",
keywords="eating detection",
keywords="eating behavior",
keywords="eating context",
keywords="well-being",
keywords="smartwatch",
keywords="ecological momentary assessment",
abstract="Background: Eating behavior has a high impact on the well-being of an individual. Such behavior involves not only when an individual is eating, but also various contextual factors such as with whom and where an individual is eating and what kind of food the individual is eating. Despite the relevance of such factors, most automated eating detection systems are not designed to capture contextual factors. Objective: The aims of this study were to (1) design and build a smartwatch-based eating detection system that can detect meal episodes based on dominant hand movements, (2) design ecological momentary assessment (EMA) questions to capture meal contexts upon detection of a meal by the eating detection system, and (3) validate the meal detection system that triggers EMA questions upon passive detection of meal episodes. Methods: The meal detection system was deployed among 28 college students at a US institution over a period of 3 weeks. The participants reported various contextual data through EMAs triggered when the eating detection system correctly detected a meal episode. The EMA questions were designed after conducting a survey study with 162 students from the same campus. Responses from EMAs were used to define exclusion criteria. Results: Among the total consumed meals, 89.8\% (264/294) of breakfast, 99.0\% (406/410) of lunch, and 98.0\% (589/601) of dinner episodes were detected by our novel meal detection system. The eating detection system showed a high accuracy by capturing 96.48\% (1259/1305) of the meals consumed by the participants. The meal detection classifier showed a precision of 80\%, recall of 96\%, and F1 of 87.3\%. We found that over 99\% (1248/1259) of the detected meals were consumed with distractions. Such eating behavior is considered ``unhealthy'' and can lead to overeating and uncontrolled weight gain. A high proportion of meals was consumed alone (680/1259, 54.01\%). Our participants self-reported 62.98\% (793/1259) of their meals as healthy. Together, these results have implications for designing technologies to encourage healthy eating behavior. Conclusions: The presented eating detection system is the first of its kind to leverage EMAs to capture the eating context, which has strong implications for well-being research. We reflected on the contextual data gathered by our system and discussed how these insights can be used to design individual-specific interventions. ",
doi="10.2196/20625",
url="http://mhealth.jmir.org/2020/12/e20625/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33337336"
}


@Article{info:doi/10.2196/19991,
author="Laranjo, Liliana
and Quiroz, C. Juan
and Tong, Ly Huong
and Arevalo Bazalar, Maria
and Coiera, Enrico",
title="A Mobile Social Networking App for Weight Management and Physical Activity Promotion: Results From an Experimental Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="8",
volume="22",
number="12",
pages="e19991",
keywords="mobile apps",
keywords="fitness trackers",
keywords="exercise",
keywords="social networking",
keywords="body weight maintenance",
keywords="mobile phone",
abstract="Background: Smartphone apps, fitness trackers, and online social networks have shown promise in weight management and physical activity interventions. However, there are knowledge gaps in identifying the most effective and engaging interventions and intervention features preferred by their users. Objective: This 6-month pilot study on a social networking mobile app connected to wireless weight and activity tracking devices has 2 main aims: to evaluate changes in BMI, weight, and physical activity levels in users from different BMI categories and to assess user perspectives on the intervention, particularly on social comparison and automated self-monitoring and feedback features. Methods: This was a mixed methods study involving a one-arm, pre-post quasi-experimental pilot with postintervention interviews and focus groups. Healthy young adults used a social networking mobile app intervention integrated with wireless tracking devices (a weight scale and a physical activity tracker) for 6 months. Quantitative results were analyzed separately for 2 groups---underweight-normal and overweight-obese BMI---using t tests and Wilcoxon sum rank, Wilcoxon signed rank, and chi-square tests. Weekly BMI change in participants was explored using linear mixed effects analysis. Interviews and focus groups were analyzed inductively using thematic analysis. Results: In total, 55 participants were recruited (mean age of 23.6, SD 4.6 years; 28 women) and 45 returned for the final session (n=45, 82\% retention rate). There were no differences in BMI from baseline to postintervention (6 months) and between the 2 BMI groups. However, at 4 weeks, participants' BMI decreased by 0.34 kg/m2 (P<.001), with a loss of 0.86 kg/m2 in the overweight-obese group (P=.01). Participants in the overweight-obese group used the app significantly less compared with individuals in the underweight-normal BMI group, as they mentioned negative feelings and demotivation from social comparison, particularly from upward comparison with fitter people. Participants in the underweight-normal BMI group were avid users of the app's self-monitoring and feedback (P=.02) and social (P=.04) features compared with those in the overweight-obese group, and they significantly increased their daily step count over the 6-month study duration by an average of 2292 steps (95\% CI 898-3370; P<.001). Most participants mentioned a desire for a more personalized intervention. Conclusions: This study shows the effects of different interventions on participants from higher and lower BMI groups and different perspectives regarding the intervention, particularly with respect to its social features. Participants in the overweight-obese group did not sustain a short-term decrease in their BMI and mentioned negative emotions from app use, while participants in the underweight-normal BMI group used the app more frequently and significantly increased their daily step count. These differences highlight the importance of intervention personalization. Future research should explore the role of personalized features to help overcome personal barriers and better match individual preferences and needs. ",
doi="10.2196/19991",
url="http://www.jmir.org/2020/12/e19991/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289670"
}


@Article{info:doi/10.2196/21436,
author="Goni, Leticia
and de la O, V{\'i}ctor
and Barrio-L{\'o}pez, Teresa M.
and Ramos, Pablo
and Tercedor, Luis
and Iba{\~n}ez-Criado, Luis Jose
and Castellanos, Eduardo
and Iba{\~n}ez Criado, Alicia
and Macias Ruiz, Rosa
and Garc{\'i}a-Bolao, Ignacio
and Almendral, Jesus
and Mart{\'i}nez-Gonz{\'a}lez, {\'A}ngel Miguel
and Ruiz-Canela, Miguel",
title="A Remote Nutritional Intervention to Change the Dietary Habits of Patients Undergoing Ablation of Atrial Fibrillation: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="7",
volume="22",
number="12",
pages="e21436",
keywords="atrial fibrillation",
keywords="secondary prevention",
keywords="remote intervention",
keywords="Mediterranean diet",
keywords="olive oil",
abstract="Background: The Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored. Objective: This study aims to assess the effectiveness of a remotely provided Mediterranean diet--based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF). Methods: The PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the Mediterranean diet enriched with extra virgin olive oil (EVOO) on the prevention of atrial tachyarrhythmia recurrence after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (Mediterranean diet enriched with EVOO) or a control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with provision of dietary recommendations, and participants had access to a web page, a mobile app, and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, Mediterranean diet classroom, and Your personal experience. At baseline and at 1-year and 2-year follow-up, the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire were collected by a dietitian by phone. Results: A total of 720 subjects were randomized (365 to the intervention group, 355 to the control group). Up to September 2020, 560 subjects completed the first year (560/574, retention rate 95.6\%) and 304 completed the second year (304/322, retention rate 94.4\%) of the intervention. After 24 months of follow-up, increased adherence to the Mediterranean diet was observed in both groups, but the improvement was significantly higher in the intervention group than in the control group (net between-group difference: 1.8 points in the MEDAS questionnaire (95\% CI 1.4-2.2; P<.001). Compared with the control group, the Mediterranean diet intervention group showed a significant increase in the consumption of fruits (P<.001), olive oil (P<.001), whole grain cereals (P=.002), pulses (P<.001), nuts (P<.001), white fish (P<.001), fatty fish (P<.001), and white meat (P=.007), and a significant reduction in refined cereals (P<.001), red and processed meat (P<.001), and sweets (P<.001) at 2 years of intervention. In terms of nutrients, the intervention group significantly increased their intake of omega-3 (P<.001) and fiber (P<.001), and they decreased their intake of carbohydrates (P=.02) and saturated fatty acids (P<.001) compared with the control group. Conclusions: The remote nutritional intervention using a website and phone calls seems to be effective in increasing adherence to the Mediterranean diet pattern among AF patients treated with catheter ablation. Trial Registration: ClinicalTrials.gov NCT03053843; https://www.clinicaltrials.gov/ct2/show/NCT03053843 ",
doi="10.2196/21436",
url="http://www.jmir.org/2020/12/e21436/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284131"
}


@Article{info:doi/10.2196/17536,
author="Steinberg, M. Dori
and Kay, C. Melissa
and Svetkey, P. Laura
and Askew, Sandy
and Christy, Jacob
and Burroughs, Jasmine
and Ahmed, Hira
and Bennett, G. Gary",
title="Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="7",
volume="8",
number="12",
pages="e17536",
keywords="hypertension",
keywords="DASH dietary pattern",
keywords="digital health",
keywords="nutrition",
keywords="women's health",
keywords="mHealth",
abstract="Background: Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective: This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods: We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results: The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69\%) and college educated (49/59, 83\%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95\% CI 0.2-1.5 vs 0.8, 95\% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: --2.8 mmHg, 95\% CI --1.8 to 7.4; P=.23) and diastolic (mean difference: --3.6 mmHg, 95\% CI --0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79\%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34\% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions: A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration: ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472 ",
doi="10.2196/17536",
url="https://mhealth.jmir.org/2020/12/e17536",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284116"
}


@Article{info:doi/10.2196/18104,
author="Krukowski, Rebecca
and Kim, Hyeonju
and Stansbury, Melissa
and Li, Qian
and Sen, Saunak
and Farage, Gregory
and West, Delia",
title="Importance of Multiple Reinforcing Comments and Areas for Change in Optimizing Dietary and Exercise Self-Monitoring Feedback in Behavioral Weight Loss Programs: Factorial Design",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="23",
volume="22",
number="11",
pages="e18104",
keywords="overweight",
keywords="obesity",
keywords="weight loss",
keywords="feedback",
keywords="diet records",
keywords="compliance",
keywords="counselor",
abstract="Background: Individualized dietary and physical activity self-monitoring feedback is a core element of behavioral weight loss interventions and is associated with clinically significant weight loss. To our knowledge, no studies have evaluated individuals' perspectives on the composition of feedback messages or the effect of feedback composition on the motivation to self-monitor. Objective: This study aims to assess the perceptions of feedback emails as a function of the number of comments that reinforce healthy behavior and the number of areas for change (ie, behavioral changes that the individual might make to have an impact on weight) identified. Methods: Emailed feedback followed a factorial design with 2 factors (ie, reinforcing comments and areas for change), each with 3 levels (ie, 1, 4, or 8 comments). A total of 250 adults with overweight or obesity who were interested in weight loss were recruited from the Qualtrics research panel. Participants read 9 emails presented in a random order. For each email, respondents answered 8 questions about the likelihood to self-monitor in the future, motivation for behavioral change, and perceptions of the counselor and the email. A mixed effects ordinal logistic model was used to compute conditional odds ratios and predictive margins (ie, average predicted probability) on a 5-point Likert response scale to investigate the optimal combination level of the 2 factors. Results: Emails with more reinforcing comments or areas for change were better received, with small incremental benefits for 8 reinforcing comments or areas for change versus 4 reinforcing comments or areas for change. Interactions indicated that the best combination for 3 of 8 outcomes assessed (ie, motivation to make behavioral changes, counselor's concern for their welfare, and the perception that the counselor likes them) was the email with 8 reinforcing comments and 4 areas for change. Emails with 4 reinforcing comments and 4 areas for change resulted in the highest average probability of individuals who reported being very likely to self-monitor in the future. Conclusions: The study findings suggest how feedback might be optimized for efficacy. Future studies should explore whether the composition of feedback email affects actual self-monitoring performance. ",
doi="10.2196/18104",
url="https://www.jmir.org/2020/11/e18104",
url="http://www.ncbi.nlm.nih.gov/pubmed/33226348"
}


@Article{info:doi/10.2196/22036,
author="Grady, Alice
and Barnes, Courtney
and Wolfenden, Luke
and Lecathelinais, Christophe
and Yoong, Lin Sze",
title="Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="20",
volume="22",
number="11",
pages="e22036",
keywords="early childhood education and care",
keywords="digital health technologies",
keywords="adoption",
keywords="dissemination",
keywords="guidelines",
abstract="Background: Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. Objective: This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. Methods: A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. Results: Findings indicate that 58.9\% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization's capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. Conclusions: A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood. ",
doi="10.2196/22036",
url="http://www.jmir.org/2020/11/e22036/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33216005"
}


@Article{info:doi/10.2196/15717,
author="Kato-Lin, Yi-Chin
and Kumar, Bharath Uttara
and Sri Prakash, Bhargav
and Prakash, Bhairavi
and Varadan, Vasini
and Agnihotri, Sanjeeta
and Subramanyam, Nrutya
and Krishnatray, Pradeep
and Padman, Rema",
title="Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="18",
volume="8",
number="11",
pages="e15717",
keywords="pediatric obesity",
keywords="mobile games",
keywords="implicit learning",
keywords="healthy eating behavior evaluation",
keywords="game telemetry analysis",
abstract="Background: Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. Objective: This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children's heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players' food choices. Methods: We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. Results: We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children's game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall $\tau$=--.32, P=.04), even after controlling for baseline food preference. Conclusions: A mobile video game embedded with implicit learning components showed a strong positive impact on children's food choices immediately following the game. Game telemetry captured children's different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. Trial Registration: ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively. ",
doi="10.2196/15717",
url="http://mhealth.jmir.org/2020/11/e15717/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33206054"
}


@Article{info:doi/10.2196/24422,
author="Trolle Lagerros, Ylva
and Dahlgren, Anna
and Sj{\"o}blom, Linnea
and Bonn, E. Stephanie",
title="Digital Support for Healthier Eating Habits Among Patients With Type 2 Diabetes: Protocol for a Randomized Clinical Trial Within Primary Care (HAPPY Trial)",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="16",
volume="9",
number="11",
pages="e24422",
keywords="body composition",
keywords="diabetes",
keywords="dietary intake",
keywords="HbA1c",
keywords="metabolic health",
keywords="mHealth",
keywords="obesity",
keywords="randomized clinical trial",
keywords="serum lipids",
keywords="smartphones",
abstract="Background: Despite the large impact that dietary habits have in the management of diabetes, few tools for supporting healthy eating habits are available for persons with diabetes. Objective: The aim of this randomized clinical trial is to evaluate the effect of a 12-week, mobile health (mHealth), app-based intervention promoting healthy eating habits among patients with type 2 diabetes. Methods: The HAPPY (Healthy eating using APP technologY) trial is a randomized clinical trial with two arms aiming to include 200 patients, 18 years of age or older, with type 2 diabetes. Both women and men are eligible for inclusion. Study participants are randomized 1:1 to an intervention group, where they are instructed to use a smartphone app promoting healthy eating, or to a control group, where they receive standard primary care only, for a period of 12 weeks. Each week a new topic (eg, vegetable intake) is introduced via the app. After an introduction text, the user is given a topic-related activity to perform (eg, eat one additional serving of vegetables per day during that week). The app records daily progress and sends automatic reminders or feedback to the user. Dietary intake, body composition, clinical variables, and biomarkers are measured at baseline and at 3- and 6-month follow-ups. An extensive web-based questionnaire comprising several validated questionnaires assessing a number of lifestyle factors is distributed via email at baseline and at 3-, 6-, and 12-month follow-ups; lifestyle factors include, for example, sleep, physical activity, eating behavior, and health-related quality of life. The effect of the intervention on dietary intake (primary outcome) and on glycated hemoglobin and blood lipid levels, body composition, blood pressure, other lifestyle factors, and overall health (secondary outcomes) will be assessed. Results: Data collection is ongoing. Recruitment of participants started in January 2019. Findings from the study are expected to be published by the end of 2021. Conclusions: Technology development provides new ways to promote and support long-term adherence to healthier eating habits. mHealth-based approaches allow for real-time interaction and the delivery of an intervention at any time. Further, focusing on overall diet allows the user to apply new knowledge to current eating patterns, creating an individualized approach. In this study, we evaluate the effect of using a new smartphone app promoting healthy eating habits on dietary intake, clinical markers, and lifestyle factors among patients with type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT03784612; https://clinicaltrials.gov/ct2/show/NCT03784612 International Registered Report Identifier (IRRID): DERR1-10.2196/24422 ",
doi="10.2196/24422",
url="http://www.researchprotocols.org/2020/11/e24422/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33196448"
}


@Article{info:doi/10.2196/20534,
author="Wunsch, Kathrin
and Eckert, Tobias
and Fiedler, Janis
and Cleven, Laura
and Niermann, Christina
and Reiterer, Harald
and Renner, Britta
and Woll, Alexander",
title="Effects of a Collective Family-Based Mobile Health Intervention Called ``SMARTFAMILY'' on Promoting Physical Activity and Healthy Eating: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="11",
volume="9",
number="11",
pages="e20534",
keywords="mobile app",
keywords="telemedicine",
keywords="behavior change",
keywords="health behavior",
keywords="family",
keywords="primary prevention",
keywords="exercise",
keywords="food and nutrition",
keywords="randomized controlled trial",
keywords="accelerometer",
keywords="wearable electronic devices",
keywords="social cognitive determinants",
keywords="just-in-time adaptive intervention",
keywords="digital intervention",
keywords="mobile phone",
abstract="Background: Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Objective: The aim of this study was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features. Methods: A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Existing evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T0) and postintervention measurements (T1) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T1, a follow-up assessment (T2) is completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation. Results: This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022. Conclusions: In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects. Trial Registration: German Clinical Trials Register DRKS00010415; https://tinyurl.com/yyo87yyu International Registered Report Identifier (IRRID): DERR1-10.2196/20534 ",
doi="10.2196/20534",
url="http://www.researchprotocols.org/2020/11/e20534/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33174849"
}


@Article{info:doi/10.2196/19362,
author="Wang, Y. Elizabeth
and Graff, E. Rebecca
and Chan, M. June
and Langlais, S. Crystal
and Broering, M. Jeanette
and Ramsdill, W. Justin
and Kessler, R. Elizabeth
and Winters-Stone, M. Kerri
and Van Blarigan, L. Erin
and Kenfield, A. Stacey",
title="Web-Based Lifestyle Interventions for Prostate Cancer Survivors: Qualitative Study",
journal="JMIR Cancer",
year="2020",
month="Nov",
day="10",
volume="6",
number="2",
pages="e19362",
keywords="cancer survivorship",
keywords="digital health",
keywords="technology-based intervention",
keywords="internet-based intervention",
keywords="usability",
abstract="Background: Exercise and a healthy diet can improve the quality of life and prognosis of prostate cancer survivors, but there have been limited studies on the feasibility of web-based lifestyle interventions in this population. Objective: This study aims to develop a data-driven grounded theory of web-based engagement by prostate cancer survivors based on their experience in the Community of Wellness, a 12-week randomized clinical trial designed to support healthy diet and exercise habits. Methods: TrueNTH's Community of Wellness was a four-arm pilot study of men with prostate cancer (N=202) who received progressive levels of behavioral support (level 1: website; level 2: website with individualized diet and exercise recommendations; level 3: website with individualized diet and exercise recommendations, Fitbit, and text messages; and level 4: website with individualized diet and exercise recommendations, Fitbit and text messages, and separate phone calls with an exercise trainer and a registered dietitian). The primary aim of the study is to determine the feasibility and estimate the effects on behaviors (results reported in a separate paper). Following the 12-week intervention, we invited participants to participate in 4 focus groups, one for each intervention level. In this report, we used grounded theory analyses including open, axial, and selective coding to generate codes and themes from the focus group transcripts. Categories were refined across levels using embodied categorization and constant comparative methods. Results: In total, 20 men with prostate cancer participated in the focus groups: 5, 4, 5, and 6 men in levels 1, 2, 3, and 4, respectively. Participants converged on 5 common factors influencing engagement with the intervention: environment (home environment, competing priorities, and other lifestyle programs), motivation (accountability and discordance experienced within the health care system), preparedness (technology literacy, health literacy, trust, and readiness to change), program design (communication, materials, and customization), and program support (education, ally, and community). Each of these factors influenced the survivors' long-term impressions and habits. We proposed a grounded theory associating these constructs to describe the components contributing to the intuitiveness of a web-based lifestyle intervention. Conclusions: These analyses suggest that web-based lifestyle interventions are more intuitive when we optimize participants' technology and health literacy; tailor interface design, content, and feedback; and leverage key motivators (ie, health care providers, family members, web-based coach) and environmental factors (ie, familiarity with other lifestyle programs). Together, these grounded theory--based efforts may improve engagement with web-based interventions designed to support prostate cancer survivorship. ",
doi="10.2196/19362",
url="http://cancer.jmir.org/2020/2/e19362/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33170126"
}


@Article{info:doi/10.2196/19488,
author="Karimi, Nazgol
and Crawford, David
and Opie, Rachelle
and Maddison, Ralph
and O'Connell, Stella
and Hamblin, Shane Peter
and Ng, Huixian Ashley
and Steele, Cheryl
and Rasmussen, Bodil
and Ball, Kylie",
title="EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study",
journal="JMIR Res Protoc",
year="2020",
month="Nov",
day="6",
volume="9",
number="11",
pages="e19488",
keywords="type 2 diabetes",
keywords="healthy eating",
keywords="diet",
keywords="low socioeconomic position",
keywords="self-management",
keywords="digitally delivered",
keywords="internet",
keywords="website",
keywords="mobile phone",
keywords="text message",
abstract="Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 International Registered Report Identifier (IRRID): DERR1-10.2196/19488 ",
doi="10.2196/19488",
url="https://www.researchprotocols.org/2020/11/e19488",
url="http://www.ncbi.nlm.nih.gov/pubmed/33155571"
}


@Article{info:doi/10.2196/17494,
author="Beleigoli, Alline
and Andrade, Q. Andre
and Diniz, Fatima Maria De
and Ribeiro, Luiz Antonio",
title="Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="5",
volume="22",
number="11",
pages="e17494",
keywords="obesity",
keywords="overweight",
keywords="healthy eating",
keywords="diet",
keywords="digital health",
keywords="web platform",
keywords="online coaching",
keywords="personalized web interventions",
abstract="Background: The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear. Objective: We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity. Methods: This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ?25 kg/m2, and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes. Results: Among the 1298 participants, 375 (28.89\%) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (--1.08 kg, 95\% CI --1.41 to --0.75 vs --1.57 kg, 95\% CI --1.92 to --1.22 vs --0.66 kg, 95\% CI --0.98 to --0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3\%, 95\% CI 1\% to 6\% vs 5\%, 95\% CI 2\% to 8\% vs --3\%, 95\% CI --5\% to 0\%) and fruits (9\%, 95\% CI 6\% to 12\% vs 6\%, 95\% CI 2\% to 9\% vs 2\%, 95\% CI 0\% to 6\%) and a larger reduction in ultraprocessed food intake (--18\%, 95\% CI --23\% to --13\% vs --25\%, 95\% CI --30\% to --20\% vs --12\%, 95\% CI --16\% to --8\%). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; P=.007). Longer usage of the platform was associated with clinically meaningful (?5\%) weight loss (odds ratio 1.02, 95\% CI 1.01 to 1.04). Conclusions: The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss. Trial Registration: ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 International Registered Report Identifier (IRRID): RR2-10.2196/10.1186/s12889-018-5882-y ",
doi="10.2196/17494",
url="https://www.jmir.org/2020/11/e17494",
url="http://www.ncbi.nlm.nih.gov/pubmed/33151151"
}


@Article{info:doi/10.2196/18614,
author="Garnweidner-Holme, Lisa
and Henriksen, Lena
and Torheim, Elin Liv
and Lukasse, Mirjam",
title="Effect of the Pregnant+ Smartphone App on the Dietary Behavior of Women With Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="4",
volume="8",
number="11",
pages="e18614",
keywords="gestational diabetes mellitus",
keywords="diet",
keywords="mHealth",
keywords="mobile phone",
keywords="randomized controlled trial",
abstract="Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy can prevent adverse health outcomes for the mother and the newborn child. Mobile health may be a useful supplement to prenatal care, providing women with targeted dietary information concerning GDM. Objective: We analyzed secondary data from a two-arm, multicentered, nonblinded randomized controlled trial to determine if a smartphone app with targeted dietary information and blood glucose monitoring had an effect on the dietary behavior of women with GDM. Methods: Women with a 2-hour oral glucose tolerance test level of ?9 mmol/L were individually randomized to either the intervention group receiving the Pregnant+ app and usual care or the control group receiving usual care only. Eligible women were enrolled from 5 diabetes outpatient clinics in the Oslo region, Norway, between October 2015 and April 2017. The Pregnant+ app promoted 10 GDM-specific dietary recommendations. A healthy dietary score for Pregnant+ (HDS-P+) was constructed from a 41-item food frequency questionnaire and used to assess the intervention effect on the dietary behavior completed at trial entry and at around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired sample two-tailed t test. Between-group dietary differences after the intervention were estimated with analysis of covariance, with adjustment for baseline diet. Results: A total of 238 women participated: 115 were allocated to the intervention group and 123 to the control group. Of the 238 women, 193 (81.1\%) completed the food frequency questionnaire both at baseline and around gestational week 36. All the participants showed improvements in their HDS-P+ from baseline. However, the Pregnant+ app did not have a significant effect on their HDS-P+. The control group reported a higher weekly frequency of choosing fish meals (P=.05). No other significant differences were found between the intervention and control groups. There were no significant demographic baseline differences between the groups, except that more women in the intervention group had a non-Norwegian language as their first language (61 vs 46; P=.02). Conclusions: Our findings do not support the supplementation of face-to-face follow-up of women with GDM with a smartphone app in the presence of high-standard usual care, as the Pregnant+ app did not have a beneficial effect on pregnant women's diet. Trial Registration: ClinicalTrials.gov NCT02588729; https://clinicaltrials.gov/ct2/show/NCT02588729 ",
doi="10.2196/18614",
url="http://mhealth.jmir.org/2020/11/e18614/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33146620"
}


@Article{info:doi/10.2196/19869,
author="Xu, Zidu
and Geng, Ji
and Zhang, Shuai
and Zhang, Kexin
and Yang, Lin
and Li, Jing
and Li, Jiao",
title="A Mobile-Based Intervention for Dietary Behavior and Physical Activity Change in Individuals at High Risk for Type 2 Diabetes Mellitus: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="3",
volume="8",
number="11",
pages="e19869",
keywords="transtheoretical model",
keywords="type 2 diabetes mellitus",
keywords="high risk",
keywords="social media",
keywords="dietary behavior",
keywords="physical activity",
abstract="Background: Intensive lifestyle modifications have proved effective in preventing type 2 diabetes mellitus (T2DM), yet the efficiency and effectiveness of these modifications need to be improved. Emerging social media interventions are considered useful in promoting these lifestyles; nevertheless, few studies have investigated the effectiveness of combining them with behavior theory. Objective: This study aims to examine the effectiveness of a 6-month mobile-based intervention (DHealthBar, a WeChat applet) combined with behavioral theory compared with a printed intervention in improving dietary behaviors, physical activity, and intention to change these behaviors among populations at high risk for T2DM. Methods: Participants aged 23 to 67 years were recruited offline in Beijing, China, and were randomized into the intervention group or the control group, which received educational content via DHealthBar or a printed handbook, respectively. Educational materials were culturally tailored recommendations on improving dietary behaviors, physical activity, and intention to change based on the transtheoretical model. Participants in the intervention arm received push notifications twice per week on WeChat and had access to the educational content for the 6-month study period. Participants in the control arm received the same intervention content through printed materials. The outcomes of participants' behavior change, intention to change behavior, and anthropometric characteristics were collected via online measuring tools at baseline, 3 months, and 6 months. Results: In this study, 79 enrolled individuals completed baseline information collection (control: n=38 vs intervention: n=41), and 96\% (76/79) completed the 6-month follow-up visit. Attrition rates did not differ significantly between the 2 groups ($\chi$21=0.0, P=.61). Baseline equivalence was found. Participants in both groups reported a statistically significant decrease in energy intake at the 2 follow-up assessments compared with baseline (3 months, control: exp[$\beta$]=0.83, 95\% CI 0.74-0.92 vs intervention: exp[$\beta$]=0.76, 95\% CI 0.68-0.85; 6 months, control: exp[$\beta$]=0.87, 95\% CI 0.78-0.96 vs intervention: exp[$\beta$]=0.57, 95\% CI 0.51-0.64). At 6 months, a significantly larger decrease was observed in the intervention group in energy, fat, and carbohydrate intake, accompanied with a significantly larger increase in moderate-intensity physical activity compared with the control group (energy: exp[$\beta$]=0.66, 95\% CI 0.56-0.77; fat: exp[$\beta$]=0.71, 95\% CI 0.54-0.95; carbohydrates: exp[$\beta$]=0.83, 95\% CI 0.66-1.03; moderate-intensity physical activity: exp[$\beta$]=2.05, 95\% CI 1.23-3.44). After 6 months of the intervention, participants in the intervention group were more likely to be at higher stages of dietary behaviors (exp[$\beta$]=26.80, 95\% CI 3.51-204.91) and physical activity (exp[$\beta$]=15.60, 95\% CI 2.67-91.04) than the control group. Conclusions: DHealthBar was initially effective in improving dietary behavior, physical activity, and intention to change these behaviors among populations who were at high risk of developing T2DM, with significant differences in the changes of outcomes over the 6-month intervention period. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000032323; https://tinyurl.com/y4h8q4uf ",
doi="10.2196/19869",
url="https://mhealth.jmir.org/2020/11/e19869",
url="http://www.ncbi.nlm.nih.gov/pubmed/33141092"
}


@Article{info:doi/10.2196/20336,
author="Lutfeali, Samina
and Ward, Tisheya
and Greene, Tenay
and Arshonsky, Josh
and Seixas, Azizi
and Dalton, Madeline
and Bragg, A. Marie",
title="Understanding the Extent of Adolescents' Willingness to Engage With Food and Beverage Companies' Instagram Accounts: Experimental Survey Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Oct",
day="27",
volume="6",
number="4",
pages="e20336",
keywords="social media",
keywords="Instagram",
keywords="social media marketing",
keywords="food industry",
keywords="adolescents",
keywords="adolescent health",
abstract="Background: Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents' online relationships with unhealthy food brands. Objective: We aimed to understand the extent to which adolescents' preferences for Instagram food ads are shaped by the presence of comments and varying numbers of ``likes.'' We hypothesized that adolescents would show the highest preferences for ads with more ``likes'' and comments. We predicted that these differences would be greater among adolescents who were ``heavy social media users'' (ie, >3 hours daily) vs ``light social media users'' (ie, <3 hours daily). Methods: We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of ``likes.'' Adolescents reported ad preferences and willingness to engage with the brand. Results: Adolescents rated ads with medium or high numbers of ``likes'' higher than ads with few ``likes'' (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001). Conclusions: Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many ``likes,'' demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children's Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years. ",
doi="10.2196/20336",
url="https://publichealth.jmir.org/2020/4/e20336",
url="http://www.ncbi.nlm.nih.gov/pubmed/33107836"
}


@Article{info:doi/10.2196/19844,
author="Alshathri, M. Dalal
and Alhumaimeedy, S. Abeer
and Al-Hudhud, Ghada
and Alsaleh, Aseel
and Al-Musharaf, Sara
and Aljuraiban, S. Ghadeer",
title="Weight Management Apps in Saudi Arabia: Evaluation of Features and Quality",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="26",
volume="8",
number="10",
pages="e19844",
keywords="mHealth",
keywords="eHealth",
keywords="smartphone",
keywords="obesity",
keywords="weight management",
keywords="mobile apps",
keywords="MARS",
keywords="six sigma",
abstract="Background: Weight management apps may provide support and management options for individuals with overweight and obesity. Research on the quality of weight management mHealth apps among the Saudi population is insufficient despite frequent use. Objective: The aims of this study were to explore user perceptions of weight management apps, explore reasons for starting and stopping app use, appraise the quality of weight management apps available in the App Store, and compare the features currently available within the app market and those that are most desirable to weight management app users. Methods: A web-based survey consisted of 31 open and closed questions about sociodemographic information, general health questions, app use, app user perceptions, and discontinuation of app use. The quality of the weight management apps available on the App Store was assessed using the Mobile App Rating Scale and evidence-based strategies. We also used six sigma evaluations to ensure that the quality measured by the tools consistently meets customer expectations. Results: Data from the survey were analyzed. Of the respondents, 30.17\% (324/1074) had used a weight management app, 18.16\% (195/1074) used the apps and stopped, and 51.68\% (555/1074) had never used a weight management app. Of apps mentioned, 23 met the inclusion criteria. The overall average Mobile App Rating Scale quality of apps was acceptable; 30\% (7/23) received a quality mean score of 4 or higher (out of 5), and 30\% (7/23) did not meet the acceptability score of 3 or higher. Evidence-based strategy results showed that feedback was not observed in any of the apps, and motivation strategy was observed in only 1 app. The sigma results of evidence-based strategies reflect that most of the apps fail to pass the mean. Conclusions: App users desired a feature that allows them to communicate with a specialist, which is a missing in the available free apps. Despite the large number and accessibility of weight management apps, the quality and features of most are variable. It can be concluded from six sigma results that passing the mean does not ensure that the quality is consistently distributed through all app quality properties and Mobile App Rating Scale and evidence-based strategies do not give developers an indication of the acceptance of their apps by mobile users. This finding stresses the importance of reevaluating the passing criterion, which is ?50\% for designing an effective app. ",
doi="10.2196/19844",
url="http://mhealth.jmir.org/2020/10/e19844/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33104013"
}


@Article{info:doi/10.2196/18237,
author="Evenepoel, Charlotte
and Clevers, Egbert
and Deroover, Lise
and Van Loo, Wendy
and Matthys, Christophe
and Verbeke, Kristin",
title="Accuracy of Nutrient Calculations Using the Consumer-Focused Online App MyFitnessPal: Validation Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="21",
volume="22",
number="10",
pages="e18237",
keywords="dietary assessment",
keywords="MyFitnessPal",
keywords="Nubel",
keywords="nutrition",
keywords="online application",
keywords="diet",
abstract="Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. Methods: After carefully given instructions, 50 participants used MyFitnessPal to each complete a 4-day dietary record 2 times (T1 and T2), with 1 month in between T1 and T2. Nutrient intake values were calculated either manually, using the food composition database Nubel, or automatically, using the database coupled to MyFitnessPal. First, nutrient values from T1 were used as a training set to develop an algorithm that defined upper limit values for energy intake, carbohydrates, fat, protein, fiber, sugar, cholesterol, and sodium. These limits were applied to the MyFitnessPal dataset extracted at T2 to remove extremely high and likely erroneous values. Original and cleaned T2 values were correlated with the Nubel calculated values. Bias was estimated using Bland-Altman plots. Finally, we simulated the impact of using MyFitnessPal for nutrient analysis instead of Nubel on the power of a study design that correlates nutrient intake to a chosen outcome variable. Results: Per food portion, the following upper limits were defined: 1500 kilocalories for total energy intake, 95 grams (g) for carbohydrates, 92 g for fat, 52 g for protein, 22 g for fiber, 70 g for sugar, 600 mg for cholesterol, and 3600 mg for sodium. Cleaning the dataset extracted at T2 resulted in a 2.8\% rejection. Cleaned MyFitnessPal values demonstrated strong correlations with Nubel for energy intake (r=0.96), carbohydrates (r=0.90), fat (r=0.90), protein (r=0.90), fiber (r=0.80), and sugar (r=0.79), but weak correlations for cholesterol ($\rho$=0.51) and sodium ($\rho$=0.53); all P values were ?.001. No bias was found between both methods, except for a fixed bias for fiber and a proportional bias for cholesterol. A 5-10\% power loss should be taken into account when correlating energy intake and macronutrients obtained with MyFitnessPal to an outcome variable, compared to Nubel. Conclusions: Dietary analysis with MyFitnessPal is accurate and efficient for total energy intake, macronutrients, sugar, and fiber, but not for cholesterol and sodium. ",
doi="10.2196/18237",
url="http://www.jmir.org/2020/10/e18237/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33084583"
}


@Article{info:doi/10.2196/15430,
author="Ziesemer, Katrin
and K{\"o}nig, Maria Laura
and Boushey, Jo Carol
and Villinger, Karoline
and Wahl, Ronja Deborah
and Butscher, Simon
and M{\"u}ller, Jens
and Reiterer, Harald
and Schupp, Thomas Harald
and Renner, Britta",
title="Occurrence of and Reasons for ``Missing Events'' in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="14",
volume="8",
number="10",
pages="e15430",
keywords="dietary assessment",
keywords="diet records",
keywords="mobile phone",
keywords="mobile applications",
keywords="technology",
keywords="adherence",
keywords="compliance",
keywords="missing events",
keywords="Ecological Momentary Assessment",
keywords="mHealth",
abstract="Background: Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective: Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods: Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results: Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=?.11 to ?.14, Ps<.001, pseudo-R{\texttwosuperior}=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38\% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions: Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual's actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence. ",
doi="10.2196/15430",
url="https://mhealth.jmir.org/2020/10/e15430",
url="http://www.ncbi.nlm.nih.gov/pubmed/33052123"
}


@Article{info:doi/10.2196/17435,
author="Cho, Jemma So Mi
and Lee, Hyun Jung
and Shim, Jee-Seon
and Yeom, Hyungseon
and Lee, Jin Su
and Jeon, Woo Yong
and Kim, Chang Hyeon",
title="Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="9",
volume="22",
number="10",
pages="e17435",
keywords="metabolic health",
keywords="health behavior",
keywords="lifestyle modification",
keywords="mobile health",
abstract="Background: Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. Objective: We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. Methods: In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. Results: Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6\%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean --10.95, SD 2.09 mmHg; app only: mean --7.29, SD 1.83 mmHg; app with personalized coaching: mean --7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean --0.12, SD 0.30 kg; app only: mean --0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean --0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean --0.13, SD 0.34 kg; app only: mean --0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean --0.79, SD 0.38 kg; P=.08). Conclusions: Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. Trial Registration: ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271 ",
doi="10.2196/17435",
url="https://www.jmir.org/2020/10/e17435",
url="http://www.ncbi.nlm.nih.gov/pubmed/33034564"
}


@Article{info:doi/10.2196/16911,
author="Akdur, Gorkem
and Aydin, Nafiz Mehmet
and Akdur, Gizdem",
title="Adoption of Mobile Health Apps in Dietetic Practice: Case Study of Diyetkolik",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="2",
volume="8",
number="10",
pages="e16911",
keywords="mHealth",
keywords="technology acceptance",
keywords="user acceptance",
keywords="mobile apps",
keywords="diet apps",
keywords="Technology Acceptance Model",
keywords="TAM",
keywords="dietetics",
abstract="Background: Dietetics mobile health apps provide lifestyle tracking and support on demand. Mobile health has become a new trend for health service providers through which they have been shifting their services from clinical consultations to online apps. These apps usually offer basic features at no cost and charge a premium for advanced features. Although diet apps are now more common and have a larger user base, in general, there is a gap in literature addressing why users intend to use diet apps. We used Diyetkolik, Turkey's most widely used online dietetics platform for 7 years, as a case study to understand the behavioral intentions of users. Objective: The aim of this study was to investigate the factors that influence the behavioral intentions of users to adopt and use mobile health apps. We used the Technology Acceptance Model and extended it by exploring other factors such as price-value, perceived risk, and trust factors in order to assess the technology acceptance of users. Methods: We conducted quantitative research on the Diyetkolik app users by using random sampling. Valid data samples gathered from 658 app users were analyzed statistically by applying structural equation modeling. Results: Statistical findings suggested that perceived usefulness (P<.001), perceived ease of use (P<.001), trust (P<.001), and price-value (P<.001) had significant relationships with behavioral intention to use. However, no relationship between perceived risk and behavioral intention was found (P=.99). Additionally, there was no statistical significance for age (P=.09), gender (P=.98), or previous app use experience (P=.14) on the intention to use the app. Conclusions: This research is an invaluable addition to Technology Acceptance Model literature. The results indicated that 2 external factors (trust and price-value) in addition to Technology Acceptance Model factors showed statistical relevance with behavioral intention to use and improved our understanding of user acceptance of a mobile health app. The third external factor (perceived risk) did not show any statistical relevance regarding behavioral intention to use. Most users of the Diyetkolik dietetics app were hesitant in purchasing dietitian services online. Users should be frequently reassured about the security of the platform and the authenticity of the platform's dietitians to ensure that users' interactions with the dietitians are based on trust for the platform and the brand. ",
doi="10.2196/16911",
url="https://mhealth.jmir.org/2020/10/e16911",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006566"
}


@Article{info:doi/10.2196/16780,
author="Whitelock, Victoria
and Kersbergen, Inge
and Higgs, Suzanne
and Aveyard, Paul
and Halford, CG Jason
and Robinson, Eric",
title="User Experiences of a Smartphone-Based Attentive Eating App and Their Association With Diet and Weight Loss Outcomes: Thematic and Exploratory Analyses From a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="2",
volume="8",
number="10",
pages="e16780",
keywords="attentive eating",
keywords="weight loss",
keywords="smartphone app",
keywords="eHealth",
keywords="mHealth",
keywords="food intake",
keywords="obesity",
keywords="overweight",
keywords="focused attention",
keywords="participant experience",
abstract="Background: Short-term laboratory studies suggest that eating attentively can reduce food intake. However, in a recent randomized controlled trial we found no evidence that using an attentive eating smartphone app outside of the laboratory had an effect on energy intake or weight loss over 8 weeks. Objective: This research examined trial participants' experiences of using an attentive eating smartphone app and whether app usage was associated with energy intake and weight loss outcomes over 8 weeks. Methods: We conducted thematic analysis of semistructured interviews (N=38) among participants in the attentive eating smartphone app group of the trial who completed the 8-week assessment. Linear regression models examined the associations between energy intake and weight loss outcomes at 8 weeks and app usage. Results: Participants reported several barriers and facilitators to using the smartphone app, including repetition of app content, social setting, motivation, and habitual use of the app. Participants believed that using the app had some beneficial effects on their eating behavior and diet. Exploratory analyses indicated that more frequent recording of eating episodes in the app was associated with lower body weight (B=--0.02, P=.004) and greater self-reported energy intake (B=5.98, P=.01) at 8 weeks, but not body fat percentage or taste-test energy intake. Total audio clip plays, gallery views, and percentage of food entries recorded using an image were not significantly associated with energy intake or weight. Conclusions: Frequent recording of eating episodes in a smartphone app was associated with greater weight loss. There are barriers and facilitators to frequent use of an attentive eating smartphone app that may be useful to address when designing dietary behavior change smartphone apps. Trial Registration: ClinicalTrials.gov NCT03602001; https://clinicaltrials.gov/ct2/show/NCT03602001; Open Science Framework DOI 10.17605/osf.io/btzhw; https://osf.io/btzhw/ ",
doi="10.2196/16780",
url="https://mhealth.jmir.org/2020/10/e16780",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006564"
}


@Article{info:doi/10.2196/19618,
author="Teng, Shasha
and Khong, Wei Kok
and Pahlevan Sharif, Saeed
and Ahmed, Amr",
title="YouTube Video Comments on Healthy Eating: Descriptive and Predictive Analysis",
journal="JMIR Public Health Surveill",
year="2020",
month="Oct",
day="1",
volume="6",
number="4",
pages="e19618",
keywords="YouTube comments",
keywords="text mining",
keywords="healthy eating",
keywords="clustering",
keywords="structural equation modeling",
abstract="Background: Poor nutrition and food selection lead to health issues such as obesity, cardiovascular disease, diabetes, and cancer. This study of YouTube comments aims to uncover patterns of food choices and the factors driving them, in addition to exploring the sentiments of healthy eating in networked communities. Objective: The objectives of the study are to explore the determinants, motives, and barriers to healthy eating behaviors in online communities and provide insight into YouTube video commenters' perceptions and sentiments of healthy eating through text mining techniques. Methods: This paper applied text mining techniques to identify and categorize meaningful healthy eating determinants. These determinants were then incorporated into hypothetically defined constructs that reflect their thematic and sentimental nature in order to test our proposed model using a variance-based structural equation modeling procedure. Results: With a dataset of 4654 comments extracted from YouTube videos in the context of Malaysia, we apply a text mining method to analyze the perceptions and behavior of healthy eating. There were 10 clusters identified with regard to food ingredients, food price, food choice, food portion, well-being, cooking, and culture in the concept of healthy eating. The structural equation modeling results show that clusters are positively associated with healthy eating with all P values less than .001, indicating a statistical significance of the study results. People hold complex and multifaceted beliefs about healthy eating in the context of YouTube videos. Fruits and vegetables are the epitome of healthy foods. Despite having a favorable perception of healthy eating, people may not purchase commonly recognized healthy food if it has a premium price. People associate healthy eating with weight concerns. Food taste, variety, and availability are identified as reasons why Malaysians cannot act on eating healthily. Conclusions: This study offers significant value to the existing literature of health-related studies by investigating the rich and diverse social media data gleaned from YouTube. This research integrated text mining analytics with predictive modeling techniques to identify thematic constructs and analyze the sentiments of healthy eating. ",
doi="10.2196/19618",
url="https://publichealth.jmir.org/2020/4/e19618",
url="http://www.ncbi.nlm.nih.gov/pubmed/33001036"
}


@Article{info:doi/10.2196/22845,
author="Zhang, Jingwen
and Oh, Jung Yoo
and Lange, Patrick
and Yu, Zhou
and Fukuoka, Yoshimi",
title="Artificial Intelligence Chatbot Behavior Change Model for Designing Artificial Intelligence Chatbots to Promote Physical Activity and a Healthy Diet: Viewpoint",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="30",
volume="22",
number="9",
pages="e22845",
keywords="chatbot",
keywords="conversational agent",
keywords="artificial intelligence",
keywords="physical activity",
keywords="diet",
keywords="intervention",
keywords="behavior change",
keywords="natural language processing",
keywords="communication",
abstract="Background: Chatbots empowered by artificial intelligence (AI) can increasingly engage in natural conversations and build relationships with users. Applying AI chatbots to lifestyle modification programs is one of the promising areas to develop cost-effective and feasible behavior interventions to promote physical activity and a healthy diet. Objective: The purposes of this perspective paper are to present a brief literature review of chatbot use in promoting physical activity and a healthy diet, describe the AI chatbot behavior change model our research team developed based on extensive interdisciplinary research, and discuss ethical principles and considerations. Methods: We conducted a preliminary search of studies reporting chatbots for improving physical activity and/or diet in four databases in July 2020. We summarized the characteristics of the chatbot studies and reviewed recent developments in human-AI communication research and innovations in natural language processing. Based on the identified gaps and opportunities, as well as our own clinical and research experience and findings, we propose an AI chatbot behavior change model. Results: Our review found a lack of understanding around theoretical guidance and practical recommendations on designing AI chatbots for lifestyle modification programs. The proposed AI chatbot behavior change model consists of the following four components to provide such guidance: (1) designing chatbot characteristics and understanding user background; (2) building relational capacity; (3) building persuasive conversational capacity; and (4) evaluating mechanisms and outcomes. The rationale and evidence supporting the design and evaluation choices for this model are presented in this paper. Conclusions: As AI chatbots become increasingly integrated into various digital communications, our proposed theoretical framework is the first step to conceptualize the scope of utilization in health behavior change domains and to synthesize all possible dimensions of chatbot features to inform intervention design and evaluation. There is a need for more interdisciplinary work to continue developing AI techniques to improve a chatbot's relational and persuasive capacities to change physical activity and diet behaviors with strong ethical principles. ",
doi="10.2196/22845",
url="https://www.jmir.org/2020/9/e22845",
url="http://www.ncbi.nlm.nih.gov/pubmed/32996892"
}


@Article{info:doi/10.2196/19378,
author="van der Windt, Melissa
and van der Kleij, Maria Rianne
and Snoek, Marianne Katinka
and Willemsen, Paul Sten
and Dykgraaf, Maria Ramon Henny
and Laven, Elisabeth Joop Stephanus
and Schoenmakers, Sam
and Steegers-Theunissen, Maria R{\'e}gine Patricia",
title="Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="30",
volume="22",
number="9",
pages="e19378",
keywords="eHealth",
keywords="periconception period",
keywords="lifestyle intervention",
abstract="Background: Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (``blended care'') are combined, may effectively target these lifestyle behaviors. Objective: We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods: A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service ``Healthy Pregnancy'' with the eHealth platform ``Smarter Pregnancy'' (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (?12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ?30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results: A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4\% (263/450) were included in the preconception period. Moreover, 78.9\% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2\%) and men (58/61, 95.1\%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further. ",
doi="10.2196/19378",
url="http://www.jmir.org/2020/9/e19378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32996885"
}


@Article{info:doi/10.2196/19157,
author="Minian, Nadia
and Lingam, Mathangee
and Moineddin, Rahim
and Thorpe, E. Kevin
and Veldhuizen, Scott
and Dragonetti, Rosa
and Zawertailo, Laurie
and Taylor, H. Valerie
and Hahn, Margaret
and deRuiter, K. Wayne
and Melamed, Osnat
and Selby, Peter",
title="Impact of a Web-Based Clinical Decision Support System to Assist Practitioners in Addressing Physical Activity and/or Healthy Eating for Smoking Cessation Treatment: Protocol for a Hybrid Type I Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="29",
volume="9",
number="9",
pages="e19157",
keywords="smoking cessation",
keywords="physical activity",
keywords="healthy eating",
keywords="clinical decision support system",
keywords="hybrid type 1",
abstract="Background: Modifiable risk factors such as tobacco use, physical inactivity, and poor diet account for a significant proportion of the preventable deaths in Canada. These factors are also known to cluster together, thereby compounding the risks of morbidity and mortality. Given this association, smoking cessation programs appear to be well-suited for integration of health promotion activities for other modifiable risk factors. The Smoking Treatment for Ontario Patients (STOP) program is a province-wide smoking cessation program that currently encourages practitioners to deliver Screening, Brief Intervention, and Referral to treatment for patients who are experiencing depressive symptoms or consume excessive amounts of alcohol via a web-enabled clinical decision support system. However, there is no available clinical decision support system for physical inactivity and poor diet, which are among the leading modifiable risk factors for chronic diseases. Objective: The aim of this study is to assess whether adding a computerized/web-enabled clinical decision support system for physical activity and diet to a smoking cessation program affects smoking cessation outcomes. Methods: This study is designed as a hybrid type 1 effectiveness/implementation randomized controlled trial to evaluate a web-enabled clinical decision support system for supporting practitioners in addressing patients' physical activity and diet as part of smoking cessation treatment in a primary care setting. This design was chosen as it allows for simultaneous testing of the intervention, its delivery in target settings, and the potential for implementation in real-world situations. Intervention effectiveness will be measured using a two-arm randomized controlled trial. Health care practitioners will be unblinded to their patients' treatment allocation; however, patients will be blinded to whether their practitioner receives the clinical decision support system for physical activity and/or fruit/vegetable consumption. The evaluation of implementation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: Recruitment for the primary outcome of this study is ongoing and will be completed in November 2020. Results will be reported in March 2021. Conclusions: The findings of the study will provide much needed insight into whether adding a computerized/web-enabled clinical decision support system for physical activity and diet to a smoking cessation program affects smoking cessation outcome. Furthermore, the implementation evaluation would provide insight into the feasibility of online-based interventions for physical activity and diet in a smoking cessation program. Addressing these risk factors simultaneously could have significant positive effects on chronic disease and cancer prevention. Trial Registration: ClinicalTrials.gov NCT04223336; https://clinicaltrials.gov/ct2/show/NCT04223336 International Registered Report Identifier (IRRID): DERR1-10.2196/19157 ",
doi="10.2196/19157",
url="http://www.researchprotocols.org/2020/9/e19157/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32990250"
}


@Article{info:doi/10.2196/17685,
author="Milne-Ives, Madison
and Lam, Ching
and van Velthoven, Michelle
and Meinert, Edward",
title="Mobile Fitness and Weight Management Apps: Protocol for a Quality Evaluation",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="24",
volume="9",
number="9",
pages="e17685",
keywords="mobile apps",
keywords="telemedicine",
keywords="smartphone",
keywords="exercise",
keywords="weight loss",
keywords="obesity",
keywords="physical fitness",
keywords="fitness trackers",
abstract="Background: Obesity is a contributing factor for many noncommunicable diseases and a growing problem worldwide. Many mobile apps have been developed to help users improve their fitness and weight management behaviors. However, the speed at which apps are created and updated means that it is important to periodically assess their quality. Objective: The purpose of this study is to evaluate the quality of fitness and weight management mobile health apps using the Mobile Application Rating Scale (MARS). It will also describe the features of the included apps and compare the results to a previous evaluation conducted in 2015. Methods: Searches for ``fitness,'' ``weight,'' ``exercise,'' ``physical activity,'' ``diet,'' ``eat*,'' and ``food'' will be conducted in the Apple App Store and Google Play. Apps that have been updated over the past 5 years will be included. Two reviewers will rate the apps' quality using the MARS objective and subjective quality subscales. Interrater reliability will also be assessed. Features included in high-quality apps will be assessed, and changes in quality, features, and behavior change techniques made during the past 5 years will be described. Results: The results will be included in the evaluation paper, which we aim to publish in 2020. Conclusions: This evaluation will assess the quality of currently available fitness and weight management apps. International Registered Report Identifier (IRRID): PRR1-10.2196/17685 ",
doi="10.2196/17685",
url="http://www.researchprotocols.org/2020/9/e17685/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969830"
}


@Article{info:doi/10.2196/19897,
author="Li, Juan
and Maharjan, Bikesh
and Xie, Bo
and Tao, Cui",
title="A Personalized Voice-Based Diet Assistant for Caregivers of Alzheimer Disease and Related Dementias: System Development and Validation",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="21",
volume="22",
number="9",
pages="e19897",
keywords="Alzheimer disease",
keywords="dementia",
keywords="diet",
keywords="knowledge",
keywords="ontology",
keywords="voice assistant",
abstract="Background: The world's aging population is increasing, with an expected increase in the prevalence of Alzheimer disease and related dementias (ADRD). Proper nutrition and good eating behavior show promise for preventing and slowing the progression of ADRD and consequently improving patients with ADRD's health status and quality of life. Most ADRD care is provided by informal caregivers, so assisting caregivers to manage patients with ADRD's diet is important. Objective: This study aims to design, develop, and test an artificial intelligence--powered voice assistant to help informal caregivers manage the daily diet of patients with ADRD and learn food and nutrition-related knowledge. Methods: The voice assistant is being implemented in several steps: construction of a comprehensive knowledge base with ontologies that define ADRD diet care and user profiles, and is extended with external knowledge graphs; management of conversation between users and the voice assistant; personalized ADRD diet services provided through a semantics-based knowledge graph search and reasoning engine; and system evaluation in use cases with additional qualitative evaluations. Results: A prototype voice assistant was evaluated in the lab using various use cases. Preliminary qualitative test results demonstrate reasonable rates of dialogue success and recommendation correctness. Conclusions: The voice assistant provides a natural, interactive interface for users, and it does not require the user to have a technical background, which may facilitate senior caregivers' use in their daily care tasks. This study suggests the feasibility of using the intelligent voice assistant to help caregivers manage patients with ADRD's diet. ",
doi="10.2196/19897",
url="http://www.jmir.org/2020/9/e19897/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955452"
}


@Article{info:doi/10.2196/21813,
author="Espinosa-Curiel, Edrein Ismael
and Pozas-Bogarin, Efr{\'e}n Edgar
and Mart{\'i}nez-Miranda, Juan
and P{\'e}rez-Espinosa, Humberto",
title="Relationship Between Children's Enjoyment, User Experience Satisfaction, and Learning in a Serious Video Game for Nutrition Education: Empirical Pilot Study",
journal="JMIR Serious Games",
year="2020",
month="Sep",
day="17",
volume="8",
number="3",
pages="e21813",
keywords="Serious video games",
keywords="children",
keywords="enjoyment",
keywords="user experience",
keywords="satisfaction",
keywords="game-based learning",
keywords="nutrition",
keywords="serious game",
keywords="pilot study",
abstract="Background: The design and use of serious video games for children have increased in recent years. To maximize the effects of these games, it is essential to understand the children's experiences through playing. Previous studies identified that enjoyment and user experience satisfaction of the players are principal factors that can influence the success of serious video games and the learning of their players. However, research about the relationship between enjoyment and user experience satisfaction with learning in children 8 to 10 years old is sparse. Objective: We examined the relationship of enjoyment and user experience satisfaction with the learning of children aged 8 to 10 years while playing a serious video game for health, FoodRateMaster. This serious video game teaches children about the characteristics of healthy and unhealthy foods and how to identify them in their environment. Methods: Children aged 8 to 10 years were recruited from a primary school in Mexico. Participants completed 12 individual gaming sessions with FoodRateMaster in 6 weeks. A food knowledge questionnaire was administered before and after game play to assess the players' food knowledge. In addition, after the gaming sessions, the children's enjoyment and user experience satisfaction were evaluated using the EGameFlow questionnaire and the Game User Experience Satisfaction Scale (GUESS) questionnaire. Results: We found significant positive associations for children's (n=60) posttest knowledge with enjoyment (r58=0.36, P=.005) and user experience satisfaction (r58=0.27, P=.04). The children's posttest knowledge scores were also positively correlated with challenge (r58=0.38, P=.003), knowledge improvement (r58=0.38, P=.003), and goal clarity (r58=0.29, P=.02) EGameFlow subscales and with narrative (r58=0.35, P=.006), creative freedom (r58=0.26, P=.04), and visual esthetics (r58=0.32, P=.01) GUESS subscales. Regression analysis indicated that the EGameFlow (F7,52=2.74, P=.02, R2=0.27) and the GUESS (F8,51=2.20, P=.04, R2=0.26) ratings significantly predicted the children's posttest knowledge scores. EGameFlow challenge ($\beta$=0.40, t52=2.17, P=.04) and knowledge improvement ($\beta$=0.29, t52=2.06, P=.04) subscales significantly contributed to predicting children's learning. None of the GUESS subscales significantly contributed to predicting children's learning. Conclusions: The findings of this study suggest that both enjoyment and user experience satisfaction for children aged 8 to 10 years were positively correlated with their learning and that were significant predictors of it. Challenge, knowledge improvement, narrative, creative freedom, and visual esthetics subscales correlated positively with children's learning. In addition, challenge and knowledge improvement contributed to predicting their learning. These results are relevant to consider during the design stages of serious games developed for young children's learning purposes. ",
doi="10.2196/21813",
url="http://games.jmir.org/2020/3/e21813/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32940609"
}


@Article{info:doi/10.2196/18621,
author="Byaruhanga, Judith
and Atorkey, Prince
and McLaughlin, Matthew
and Brown, Alison
and Byrnes, Emma
and Paul, Christine
and Wiggers, John
and Tzelepis, Flora",
title="Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="11",
volume="22",
number="9",
pages="e18621",
keywords="telehealth",
keywords="videoconferencing",
keywords="smoking cessation",
keywords="diet",
keywords="alcohol drinking",
keywords="physical activity",
keywords="obesity",
keywords="mobile phone",
abstract="Background: Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective: This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods: The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results: A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions: Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility. ",
doi="10.2196/18621",
url="http://www.jmir.org/2020/9/e18621/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915156"
}


@Article{info:doi/10.2196/17919,
author="Shoneye, L. Charlene
and Mullan, Barbara
and Begley, Andrea
and Pollard, M. Christina
and Jancey, Jonine
and Kerr, A. Deborah",
title="Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="9",
volume="8",
number="9",
pages="e17919",
keywords="obesity",
keywords="diet",
keywords="physical activity",
keywords="sedentary behavior",
keywords="digital behavioral interventions",
keywords="health behavior",
keywords="wearable activity monitor",
keywords="health",
keywords="mobile food record",
keywords="clinical trial",
keywords="focus group",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. Objective: The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. Methods: This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. Results: Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. Conclusions: This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. International Registered Report Identifier (IRRID): RR2-10.2196/12782 ",
doi="10.2196/17919",
url="https://mhealth.jmir.org/2020/9/e17919",
url="http://www.ncbi.nlm.nih.gov/pubmed/32641284"
}


@Article{info:doi/10.2196/16953,
author="Ji, Yuwei
and Plourde, Hugues
and Bouzo, Valerie
and Kilgour, D. Robert
and Cohen, R. Tamara",
title="Validity and Usability of a Smartphone Image-Based Dietary Assessment App Compared to 3-Day Food Diaries in Assessing Dietary Intake Among Canadian Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="9",
volume="8",
number="9",
pages="e16953",
keywords="mobile food record",
keywords="validity",
keywords="image-based dietary assessment",
keywords="healthy adults",
keywords="3-day food diary",
keywords="diet",
keywords="application",
keywords="nutrition",
keywords="mHealth",
keywords="Canada",
abstract="Background: Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals. Objective: This study aimed to assess the relative validity of an image-based dietary assessment app --- Keenoa --- against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults. Methods: We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, \% difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian). Results: The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, \% fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10\% except for vitamin D (misclassification rate=33.8\%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (\%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2\% of the participants preferred using Keenoa, while 9.6\% preferred the 3DFD. Conclusions: The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, \% fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches. ",
doi="10.2196/16953",
url="https://mhealth.jmir.org/2020/9/e16953",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902389"
}


@Article{info:doi/10.2196/19634,
author="Hu, A. Emily
and Nguyen, Viet
and Langheier, Jason
and Shurney, Dexter",
title="Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="2",
volume="22",
number="9",
pages="e19634",
keywords="digital",
keywords="nutrition",
keywords="meal planning",
keywords="weight loss",
keywords="obese",
keywords="food environment",
keywords="food ordering",
keywords="food purchasing",
keywords="behavioral economics",
keywords="behavior change",
keywords="eating behavior",
keywords="mHealth",
keywords="app",
abstract="Background: Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity. Objective: The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory. Methods: We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95\% CI of achieving 5\% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score. Results: Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59\% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3\% achieved 5\% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95\% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95\% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95\% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95\% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5\% weight loss. Conclusions: This study found that a digital app that provides personalized nutrition recommendations and change in one's food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity. ",
doi="10.2196/19634",
url="http://www.jmir.org/2020/9/e19634/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32792332"
}


@Article{info:doi/10.2196/17790,
author="Sequi-Dominguez, Irene
and Alvarez-Bueno, Celia
and Martinez-Vizcaino, Vicente
and Fernandez-Rodriguez, Rub{\'e}n
and del Saz Lara, Alicia
and Cavero-Redondo, Iv{\'a}n",
title="Effectiveness of Mobile Health Interventions Promoting Physical Activity and Lifestyle Interventions to Reduce Cardiovascular Risk Among Individuals With Metabolic Syndrome: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="31",
volume="22",
number="8",
pages="e17790",
keywords="mobile health",
keywords="mobile technology",
keywords="telemedicine",
keywords="metabolic syndrome",
keywords="physical activity",
keywords="lifestyle intervention",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Physical activity and lifestyle interventions, such as a healthy diet, have been proven to be effective approaches to manage metabolic syndrome. However, these interventions require great commitment from patients and clinicians owing to their economic costs, time consumption, and lack of immediate results. Objective: The aim of this systematic review and meta-analysis was to analyze the effect of mobile-based health interventions for reducing cardiometabolic risk through the promotion of physical activity and healthy lifestyle behaviors. Methods: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and SPORTdiscus databases were searched for experimental studies evaluating cardiometabolic risk indicators among individuals with metabolic syndrome who were included in technology-assisted physical activity and lifestyle interventions. Effect sizes, pooled mean changes, and their respective 95\% CIs were calculated using the DerSimonian and Laird method. Outcomes included the following clinical and biochemical parameters: body composition (waist circumference [WC] and BMI), blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), glucose tolerance (fasting plasma glucose [FPG] and glycated hemoglobin A1c [HbA1c]), and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], and triglycerides). Results: A total of nine studies were included in the meta-analysis. Owing to the scarcity of studies, only pooled mean pre-post changes in the intervention groups were estimated. Significant mean changes were observed for BMI (?1.70 kg/m2, 95\% CI ?3.20 to ?0.20; effect size: ?0.46; P=.03), WC (?5.77 cm, 95\% CI ?9.76 to ?1.77; effect size: ?0.54; P=.005), SBP (?7.33 mmHg, 95\% CI ?13.25 to ?1.42; effect size: ?0.43; P=.02), DBP (?3.90 mmHg, 95\% CI ?7.70 to ?0.11; effect size: ?0.44; P=.04), FPG (?3.65 mg/dL, 95\% CI ?4.79 to ?2.51; effect size: ?0.39; P<.001), and HDL-C (4.19 mg/dL, 95\% CI 2.43-5.95; effect size: 0.23; P<.001). Conclusions: Overall, mobile-based health interventions aimed at promoting physical activity and healthy lifestyle changes had a strong positive effect on cardiometabolic risk indicators among individuals with metabolic syndrome. Nevertheless, further research is required to compare this approach with usual care in order to support the incorporation of these technologies in health systems. Trial Registration: PROSPERO CRD42019125461; https://tinyurl.com/y3t4wog4. ",
doi="10.2196/17790",
url="http://www.jmir.org/2020/8/e17790/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32865503"
}


@Article{info:doi/10.2196/20679,
author="Yin, Zenong
and Errisuriz, L. Vanessa
and Evans, Martin
and Inupakutika, Devasena
and Kaghyan, Sahak
and Li, Shiyu
and Esparza, Laura
and Akopian, David
and Parra-Medina, Deborah",
title="A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development",
journal="JMIR Form Res",
year="2020",
month="Aug",
day="20",
volume="4",
number="8",
pages="e20679",
keywords="mhealth",
keywords="digital intervention",
keywords="Latino families",
keywords="rural population",
keywords="weight",
keywords="self-management",
keywords="diet",
keywords="lifestyle",
keywords="chronic disease",
doi="10.2196/20679",
url="http://formative.jmir.org/2020/8/e20679/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32726748"
}


@Article{info:doi/10.2196/17521,
author="Kim, Junetae
and Kam, Jin Hye
and Kim, Youngin
and Lee, Yura
and Lee, Jae-Ho",
title="Understanding Time Series Patterns of Weight and Meal History Reports in Mobile Weight Loss Intervention Programs: Data-Driven Analysis",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="11",
volume="22",
number="8",
pages="e17521",
keywords="weight loss",
keywords="self-reporting",
keywords="adherence",
keywords="mobile weight loss intervention",
keywords="diet",
abstract="Background: Mobile apps for weight loss provide users with convenient features for recording lifestyle and health indicators; they have been widely used for weight loss recently. Previous studies in this field generally focused on the relationship between the cumulative nature of self-reported data and the results in weight loss at the end of the diet period. Therefore, we conducted an in-depth study to explore the relationships between adherence to self-reporting and weight loss outcomes during the weight reduction process. Objective: We explored the relationship between adherence to self-reporting and weight loss outcomes during the time series weight reduction process with the following 3 research questions: ``How does adherence to self-reporting of body weight and meal history change over time?'', ``How do weight loss outcomes depend on weight changes over time?'', and ``How does adherence to the weight loss intervention change over time by gender?'' Methods: We analyzed self-reported data collected weekly for 16 weeks (January 2017 to March 2018) from 684 Korean men and women who participated in a mobile weight loss intervention program provided by a mobile diet app called Noom. Analysis of variance (ANOVA) and chi-squared tests were employed to determine whether the baseline characteristics among the groups of weight loss results were different. Based on the ANOVA results and slope analysis of the trend indicating participant behavior along the time axis, we explored the relationship between adherence to self-reporting and weight loss results. Results: Adherence to self-reporting levels decreased over time, as previous studies have found. BMI change patterns (ie, absolute BMI values and change in BMI values within a week) changed over time and were characterized in 3 time series periods. The relationships between the weight loss outcome and both meal history and self-reporting patterns were gender-dependent. There was no statistical association between adherence to self-reporting and weight loss outcomes in the male participants. Conclusions: Although mobile technology has increased the convenience of self-reporting when dieting, it should be noted that technology itself is not the essence of weight loss. The in-depth understanding of the relationship between adherence to self-reporting and weight loss outcome found in this study may contribute to the development of better weight loss interventions in mobile environments. ",
doi="10.2196/17521",
url="https://www.jmir.org/2020/8/e17521",
url="http://www.ncbi.nlm.nih.gov/pubmed/32780028"
}


@Article{info:doi/10.2196/16797,
author="Brower, Jacob
and LaBarge, C. Monica
and White, Lauren
and Mitchell, S. Marc",
title="Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e16797",
keywords="mHealth",
keywords="behavioral economics",
keywords="public health",
keywords="incentives",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points for downloading the app, referring friends, completing educational health quizzes, and health-related behaviors with long-term objectives of increasing health knowledge and encouraging healthy behaviors. During the first 3 months after program rollout in British Columbia, a number of program design elements were adjusted, creating observed differences between groups of users with respect to the potential impact of program features on user engagement levels. Objective: This study examines the impact of reducing reward size over time and explored the influence of other program features such as quiz timing, health intervention content, and type of reward program on user engagement with a mobile health (mHealth) app. Methods: Participants in this longitudinal, nonexperimental observational study included British Columbia citizens who downloaded the app between March and July 2016. A regression methodology was used to examine the impact of changes to several program design features on quiz offer acceptance and engagement with this mHealth app. Results: Our results, based on the longitudinal app use of 54,917 users (mean age 35, SD 13.2 years; 65.03\% [35,647/54,917] female), indicated that the key drivers of the likelihood of continued user engagement, in order of greatest to least impact, were (1) type of rewards earned by users (eg, movies [+355\%; P<.001], air travel [+210\%; P<.001], and grocery [+140\%; P<.001] relative to gas), (2) time delay between early offers (?64\%; P<.001), (3) the content of the health intervention (eg, healthy eating [?10\%; P<.001] vs exercise [+20\%, P<.001] relative to health risk assessments), and (4) changes in the number of points offered. Our results demonstrate that reducing the number of points associated with a particular quiz by 10\% only led to a 1\% decrease in the likelihood of offer response (P<.001) and that each of the other design features had larger impacts on participant retention than did changes in the number of points. Conclusions: The results of this study demonstrate that this program, built around the principles of behavioral economics in the form of the ongoing awarding of a small number of reward points instantly following the completion of health interventions, was able to drive significantly higher engagement levels than those demonstrated in previous literature exploring the intersection of mHealth apps and financial incentives. Previous studies have demonstrated the presence of incentive matters to user engagement; however, our results indicate that the number of points offered for these reward point--based health interventions is less important than other program design features such as the type of reward points being offered, the timing of intervention and reward offers, and the content of the health interventions in driving continued engagement by users. ",
doi="10.2196/16797",
url="https://www.jmir.org/2020/8/e16797",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773371"
}


@Article{info:doi/10.2196/16761,
author="Vargas Meza, Xanat
and Yamanaka, Toshimasa",
title="Food Communication and its Related Sentiment in Local and Organic Food Videos on YouTube",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e16761",
keywords="social networks",
keywords="framing",
keywords="semantic analysis",
keywords="sentiment analysis",
keywords="organic",
keywords="local",
keywords="food",
keywords="YouTube",
abstract="Background: Local and organic foods have shown increased importance and market size in recent years. However, attitudes, sentiment, and habits related to such foods in the context of video social networks have not been thoroughly researched. Given that such media have become some of the most important venues of internet traffic, it is relevant to investigate how sustainable food is communicated through such video social networks. Objective: This study aimed to explore the diffusion paths of local and organic foods on YouTube, providing a review of trends, coincidences, and differences among video discourses. Methods: A combined methodology involving webometric, framing, semantic, and sentiment analyses was employed. Results: We reported the results for the following two groups: organic and local organic videos. Although the content of 923 videos mostly included the ``Good Mother'' (organic and local organic: 282/808, 34.9\% and 311/866, 35.9\%, respectively), ``Natural Goodness'' (220/808, 27.2\% and 253/866, 29.2\%), and ``Undermining of Foundations'' (153/808, 18.9\% and 180/866, 20.7\%) frames, organic videos were more framed in terms of ``Frankenstein'' food (organic and local organic: 68/808, 8.4\% and 27/866, 3.1\%, respectively), with genetically modified organisms being a frequent topic among the comments. Organic videos (N=448) were better connected in terms of network metrics than local organic videos (N=475), which were slightly more framed regarding ``Responsibility'' (organic and local organic: 42/808, 5.1\% and 57/866, 6.5\%, respectively) and expressed more positive sentiment (M ranks for organic and local organic were 521.2 and 564.54, respectively, Z=2.15, P=.03). Conclusions: The results suggest that viewers considered sustainable food as part of a complex system and in a positive light and that food framed as artificial and dangerous sometimes functions as a counterpoint to promote organic food. ",
doi="10.2196/16761",
url="https://www.jmir.org/2020/8/e16761",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773370"
}


@Article{info:doi/10.2196/18292,
author="Hammons, Jean Amber
and Villegas, Elizabeth
and Olvera, Norma
and Greder, Kimberly
and Fiese, Barbara
and Teran-Garcia, Margarita
and ",
title="The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers",
journal="JMIR Pediatr Parent",
year="2020",
month="Aug",
day="10",
volume="3",
number="2",
pages="e18292",
keywords="family mealtimes",
keywords="healthy eating",
keywords="technology at the table",
keywords="parenting and mealtimes",
keywords="Hispanic culture",
keywords="obesity prevention",
abstract="Background: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. Objective: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. Methods: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. Results: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. Conclusions: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone's tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives. ",
doi="10.2196/18292",
url="http://pediatrics.jmir.org/2020/2/e18292/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32576547"
}


@Article{info:doi/10.2196/15156,
author="Krzyzanowski, C. Michelle
and Kizakevich, N. Paul
and Duren-Winfield, Vanessa
and Eckhoff, Randall
and Hampton, Joel
and Blackman Carr, T. Loneke
and McCauley, Georgia
and Roberson, B. Kristina
and Onsomu, O. Elijah
and Williams, John
and Price, Alise Amanda",
title="Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="5",
volume="8",
number="8",
pages="e15156",
keywords="exercise",
keywords="cardiovascular disease",
keywords="diary",
keywords="diet",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. Objective: We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. Methods: We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. Results: Of the 55 students in the intervention group, 27 (49\%) students in cohort 2 and 25 (45\%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. Conclusions: Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation. ",
doi="10.2196/15156",
url="https://mhealth.jmir.org/2020/8/e15156",
url="http://www.ncbi.nlm.nih.gov/pubmed/32755883"
}


@Article{info:doi/10.2196/14013,
author="Ahn, Sun Jeong
and Lee, Heejin
and Kim, Jiae
and Park, Haemin
and Kim, Woo Dong
and Lee, Eun Jung",
title="Use of a Smartphone App for Weight Loss Versus a Paper-Based Dietary Diary in Overweight Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e14013",
keywords="smartphone app",
keywords="mobile phone",
keywords="dietary self-monitoring",
keywords="randomized controlled trial",
keywords="weight loss",
abstract="Background: Mobile health (mHealth) tools may be useful platforms for dietary monitoring and assessment. Objective: This study aims to evaluate the effectiveness of a mobile dietary self-monitoring app for weight loss versus a paper-based diary among adults with a BMI of 23 kg/m2 or above. Methods: A total of 33 men and 17 women aged 18-39 years participated in a 6-week randomized controlled trial. We randomly assigned participants to one of two groups: (1) a smartphone app group (n=25) or (2) a paper-based diary group (n=25). The smartphone app group recorded foods and dietary supplements that they consumed and received immediate dietary feedback using Well-D, a dietary self-monitoring app developed by our team. The paper-based diary group was instructed to record foods or supplements that they consumed using a self-recorded diary. The primary outcomes were weight, BMI, waist circumference, body fat mass, and skeletal muscle mass. We also examined changes in nutrient intake, including energy, carbohydrate, protein, fat, dietary fiber, vitamins, and minerals, using 3-day 24-hour recalls. Differences in changes between the two groups were analyzed using independent t tests or Wilcoxon Mann-Whitney tests. All of the data were analyzed using intent-to-treat analysis. Results: The mean number of days recorded was 18.5 (SD 14.1) for the app group and 15.5 (SD 10.1) for the paper-based diary group. The differences in changes in weight, BMI, and waist circumference were not significantly different between the app group and paper-based diary group (P=.33, .34, and .70, respectively). Similarly, changes in body fat mass or skeletal muscle mass did not differ between the two groups (P=.71 and .054, respectively). Although energy intake was reduced in both groups, there was no significant difference in changes in energy intake between the two groups (P=.98). Conclusions: There were no differences in changes in anthropometric measures and nutrient intake between the app group and the paper-based diary group. Both mobile dietary self-monitoring app and paper-based diary may be useful for improving anthropometric measures. Trial Registration: Clinical Research Information Service KCT0003170; https://cris.nih.go.kr/cris/search/search\_result\_st01\_en.jsp?seq=11642\&ltype=\&rtype= ",
doi="10.2196/14013",
url="http://mhealth.jmir.org/2020/7/e14013/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32735225"
}


@Article{info:doi/10.2196/17031,
author="Lee, Ji-Soo
and Kang, Min-Ah
and Lee, Soo-Kyoung",
title="Effects of the e-Motivate4Change Program on Metabolic Syndrome in Young Adults Using Health Apps and Wearable Devices: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="30",
volume="22",
number="7",
pages="e17031",
keywords="metabolic syndrome",
keywords="telemedicine",
keywords="mobile apps",
keywords="preventive care",
keywords="wearable electronic devices",
abstract="Background: The health behaviors of young adults lag behind those of other age groups, and active health management is needed to improve health behaviors and prevent chronic diseases. In addition, developing good lifestyle habits earlier in life could reduce the risk of metabolic syndrome (MetS) later on. Objective: The aim of this study is to investigate the effects of the e-Motivate4Change program, for which health apps and wearable devices were selected based on user needs. The program was developed for the prevention and management of MetS in young adults. Methods: This experimental study used a nonequivalent control group. In total, 59 students from 2 universities in Daegu, Korea participated in the study (experimental group n=30; control group n=29). Data were collected over 4 months, from June 1 to September 30, 2018. The experimental group received a 12-week e-Motivate4Change program intervention, and the control group received MetS education and booklets without the e-Motivate4Change program intervention. Results: After the program, the experimental group had significantly higher scores for health-related lifestyle (t=3.86; P<.001) and self-efficacy (t=6.00; P<.001) than did the control group. Concerning BMI, there were significant effects by group (F=1.01; P<.001) and for the group {\texttimes} time interaction (F=4.71; P=.034). Concerning cholesterol, there were significant main effects for group (F=4.32; P=.042) and time (F=9.73; P<.001). Conclusions: The e-Motivate4Change program effectively improved participants' health-related lifestyle scores and self-efficacy, and significantly reduced their BMI and cholesterol levels. The program can be used to identify and prevent MetS among young adults. ",
doi="10.2196/17031",
url="http://www.jmir.org/2020/7/e17031/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32729838"
}


@Article{info:doi/10.2196/17967,
author="Chhabria, Karishma
and Ross, M. Kathryn
and Sacco, J. Shane
and Leahey, M. Tricia",
title="The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="28",
volume="22",
number="7",
pages="e17967",
keywords="supportive accountability",
keywords="social support",
keywords="SALLIS",
keywords="factor analysis",
keywords="obesity",
keywords="weight loss",
keywords="technology",
keywords="mobile phone",
abstract="Background: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. Objective: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. Methods: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. Results: In Study 1 (n=353), the SAM showed strong reliability (Cronbach $\alpha$=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69\% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=?0.26; P=.06). Conclusions: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. Trial Registration: ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244 ",
doi="10.2196/17967",
url="https://www.jmir.org/2020/7/e17967",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720911"
}


@Article{info:doi/10.2196/19485,
author="Champion, Elizabeth Katrina
and Gardner, Anne Lauren
and McGowan, Cyanna
and Chapman, Cath
and Thornton, Louise
and Parmenter, Belinda
and McBride, Nyanda
and Lubans, R. David
and McCann, Karrah
and Spring, Bonnie
and Teesson, Maree
and 
and Newton, Clare Nicola",
title="A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="28",
volume="4",
number="7",
pages="e19485",
keywords="primary prevention",
keywords="schools",
keywords="eHealth",
keywords="chronic disease",
keywords="mobile phone",
keywords="health promotion",
abstract="Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. ",
doi="10.2196/19485",
url="http://formative.jmir.org/2020/7/e19485/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720898"
}


@Article{info:doi/10.2196/17296,
author="Jenkins, L. Eva
and Ilicic, Jasmina
and Barklamb, M. Amy
and McCaffrey, A. Tracy",
title="Assessing the Credibility and Authenticity of Social Media Content for Applications in Health Communication: Scoping Review",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="23",
volume="22",
number="7",
pages="e17296",
keywords="review",
keywords="trust",
keywords="social media",
keywords="nutrition science",
keywords="health",
keywords="communication",
keywords="health communication",
abstract="Background: Nutrition science is currently facing issues regarding the public's perception of its credibility, with social media (SM) influencers increasingly becoming a key source for nutrition-related information with high engagement rates. Source credibility and, to an extent, authenticity have been widely studied in marketing and communications but have not yet been considered in the context of nutrition or health communication. Thus, an investigation into the factors that impact perceived source and message credibility and authenticity is of interest to inform health communication on SM. Objective: This study aims to explore the factors that impact message and source credibility (which includes trustworthiness and expertise) or authenticity judgments on SM platforms to better inform nutrition science SM communication best practices. Methods: A total of 6 databases across a variety of disciplines were searched in March 2019. The inclusion criteria were experimental studies, studies focusing on microblogs, studies focusing on healthy adult populations, and studies focusing on either source credibility or authenticity. Exclusion criteria were studies involving participants aged under 18 years and clinical populations, gray literature, blogs, WeChat conversations, web-based reviews, non-English papers, and studies not involving participants' perceptions. Results: Overall, 22 eligible papers were included, giving a total of 25 research studies. Among these studies, Facebook and Twitter were the most common SM platforms investigated. The most effective communication style differed depending on the SM platform. Factors reported to impact credibility included language used online, expertise heuristics, and bandwagon heuristics. No papers were found that assessed authenticity. Conclusions: Credibility and authenticity are important concepts studied extensively in the marketing and communications disciplines; however, further research is required in a health context. Instagram is a less-researched platform in comparison with Facebook and Twitter. ",
doi="10.2196/17296",
url="http://www.jmir.org/2020/7/e17296/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706675"
}


@Article{info:doi/10.2196/15024,
author="Coumans, J. Juul M.
and Bolman, W. Catherine A.
and Oenema, Anke
and Lechner, Lilian",
title="Predictors of Self-Determined Module Choice in a Web-Based Computer-Tailored Diet and Physical Activity Intervention: Secondary Analysis of Data From a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="23",
volume="22",
number="7",
pages="e15024",
keywords="eHealth",
keywords="computer-tailoring",
keywords="self-determination theory",
keywords="multiple health behaviors",
keywords="lifestyle promotion",
keywords="module choice",
abstract="Background: Tailoring an online intervention to participant preferences (eg, by giving participants a choice which modules to follow) may increase engagement in the intervention, motivation for behavioral change, and possibly intervention effects. So far, little is known about what characteristics predict these module choices. Filling this knowledge gap is useful for optimizing program engagement. Objective: We investigated participant choice for a dietary and/or physical activity (PA) promotion module in our web-based computer-tailored intervention based on self-determination theory (SDT) and motivational interviewing (MI). Furthermore, we investigated which demographic characteristics, current behavior, psychosocial constructs and constructs from SDT and MI, and program-related variables such as advice on which module to follow were associated with these choices. Methods: Observational data were used from the randomized controlled trial MyLifestyleCoach of participants who were randomized into the intervention condition, completed the baseline questionnaire, and made a module choice in the opening session of the intervention. Here, they received advice on their own dietary and PA behavior. At the session's end, they chose which lifestyle modules they would like to follow (both, diet, PA, or no module). Measurements included demographic information; self-reported diet and PA; and several psychosocial, SDT, and MI constructs. In total, data from 619 Dutch adults (59.6\% women; mean age was 51.9 [SD 13.5] years) were analyzed. A stepwise multinomial logistic regression analysis was conducted to investigate which characteristics are related to module choice; the diet module served as reference category as almost everyone was advised to follow this module. Results: Of this sample, 54.8\% (339/619) chose to do both the diet and PA module, 25.4\% (157/619) chose to follow the diet module, 17.8\% (110/619) preferred to follow no module, and 2.1\% (13/619) chose to do the PA module only. Furthermore, it was found that older people, those who consumed more fruit, and those who scored lower on importance to change their current diet were more likely to choose no module compared to the diet module. People who had more motivation to change their current PA and those who received strong advice compared with slight advice to follow the diet module were more likely to choose both modules compared with the diet module only. Conclusions: The results show that more than half of the sample was interested in following both the diet and PA module in this online lifestyle intervention. Several characteristics were found to be related to module choice. A future challenge is to examine how this knowledge can be used to improve future interventions, such as tailoring (messages or content) on specific groups or examining where and how MI could be used to motivate people to make a certain module choice. Trial Registration: Netherlands Trial Register NL7333; https://www.trialregister.nl/trial/7333 ",
doi="10.2196/15024",
url="http://www.jmir.org/2020/7/e15024/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706659"
}


@Article{info:doi/10.2196/17039,
author="Islam, Mohaimenul Md
and Poly, Nasrin Tahmina
and Walther, Andres Bruno
and (Jack) Li, Yu-Chuan",
title="Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e17039",
keywords="mobile app",
keywords="mHealth",
keywords="obesity",
keywords="physical activity",
keywords="weight gain prevention",
abstract="Background: Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective: The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods: PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results: A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (?1.07 kg, 95\% CI ?1.92 to ?0.21, P=.01) and body mass index (?0.45 kg/m2, 95\% CI ?0.78 to ?0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95\% CI ?2.21 to 2.55, P=.88). Conclusions: The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples. ",
doi="10.2196/17039",
url="https://mhealth.jmir.org/2020/7/e17039",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706724"
}


@Article{info:doi/10.2196/16971,
author="McMahon, Joy Emma
and Jaenke, Rachael
and Brimblecombe, Julie",
title="A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e16971",
keywords="mobile apps",
keywords="reliability and validity",
keywords="food",
keywords="diet",
keywords="environment and public health",
abstract="Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. Objective: This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. Methods: The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. Results: The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95\% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8\%) or good (n=81/196, 41.3\%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). Conclusions: These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments. ",
doi="10.2196/16971",
url="https://mhealth.jmir.org/2020/7/e16971",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706683"
}


@Article{info:doi/10.2196/16899,
author="Robles, Noem{\'i}
and Puigdom{\`e}nech Puig, Elisa
and G{\'o}mez-Calder{\'o}n, Corpus
and Saig{\'i}-Rubi{\'o}, Francesc
and Cuatrecasas Cambra, Guillem
and Zamora, Alberto
and Moharra, Montse
and Paluzi{\'e}, Guillermo
and Balfeg{\'o}, Mariona
and Carrion, Carme",
title="Evaluation Criteria for Weight Management Apps: Validation Using a Modified Delphi Process",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e16899",
keywords="mHealth",
keywords="technology assessment",
keywords="obesity",
keywords="overweight",
keywords="Delphi technique",
keywords="consensus",
abstract="Background: The use of apps for weight management has increased over recent years; however, there is a lack of evidence regarding the efficacy and safety of these apps. The EVALAPPS project will develop and validate an assessment instrument to specifically assess the safety and efficacy of weight management apps. Objective: The aim of this study was to reach a consensus among stakeholders on a comprehensive set of criteria to guide development of the EVALAPPS assessment instrument. A modified Delphi process was used in order to verify the robustness of the criteria that had been identified through a literature review and to prioritize a set of the identified criteria. Methods: Stakeholders (n=31) were invited to participate in a 2-round Delphi process with 114 initial criteria that had been identified from the literature. In round 1, participants rated criteria according to relevance on a scale from 0 (``I suggest this criterion is excluded'') to 5 (``This criterion is extremely relevant''). A criterion was accepted if the median rating was 4 or higher and if the relative intraquartile range was equal to 0.67 or lower. In round 2, participants were asked about criteria that had been discarded in round 1. A prioritization strategy was used to identify crucial criteria according to (1) the importance attributed by participants (criteria with a mean rating of 4.00 or higher), (2) the level of consensus (criteria with a score of 4 or 5 by at least 80\% of the participants). Results: The response rate was 83.9\% (26/31) in round 1 and 90.3\% (28/31) in round 2. A total of 107 out of 114 criteria (93.9\%) were accepted by consensus---105 criteria in round 1 and 2 criteria in round 2. After prioritization, 53 criteria were deemed crucial. These related mainly to the dimensions of security and privacy (13/53, 24.5\%) and usability (9/53, 17.0\%), followed by activity data (5/53, 9.4\%), clinical effectiveness (5/53, 9.4\%), and reliability (5/53, 9.4\%). Conclusions: Results confirmed the robustness of the criteria that were identified, with those relating to security and privacy being deemed most relevant by stakeholders. Additionally, a specific set of criteria based on health indicators (activity data, physical state data, and personal data) was also prioritized. ",
doi="10.2196/16899",
url="http://mhealth.jmir.org/2020/7/e16899/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706689"
}


@Article{info:doi/10.2196/16405,
author="Dimitratos, M. Sarah
and German, Bruce J.
and Schaefer, E. Sara",
title="Wearable Technology to Quantify the Nutritional Intake of Adults: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e16405",
keywords="wearable technology",
keywords="mobile health",
keywords="mobile phone",
keywords="food intake",
keywords="validation study",
abstract="Background: Wearable and mobile sensor technologies can be useful tools in precision nutrition research and practice, but few are reliable for obtaining accurate and precise measurements of diet and nutrition. Objective: This study aimed to assess the ability of wearable technology to monitor the nutritional intake of adult participants. This paper describes the development of a reference method to validate the wristband's estimation of daily nutritional intake of 25 free-living study participants and to evaluate the accuracy (kcal/day) and practical utility of the technology. Methods: Participants were asked to use a nutrition tracking wristband and an accompanying mobile app consistently for two 14-day test periods. A reference method was developed to validate the estimation of daily nutritional intake of participants by the wristband. The research team collaborated with a university dining facility to prepare and serve calibrated study meals and record the energy and macronutrient intake of each participant. A continuous glucose monitoring system was used to measure adherence with dietary reporting protocols, but these findings are not reported. Bland-Altman tests were used to compare the reference and test method outputs (kcal/day). Results: A total of 304 input cases were collected of daily dietary intake of participants (kcal/day) measured by both reference and test methods. The Bland-Altman analysis had a mean bias of ?105 kcal/day (SD 660), with 95\% limits of agreement between ?1400 and 1189. The regression equation of the plot was Y=?0.3401X+1963, which was significant (P<.001), indicating a tendency for the wristband to overestimate for lower calorie intake and underestimate for higher intake. Researchers observed transient signal loss from the sensor technology of the wristband to be a major source of error in computing dietary intake among participants. Conclusions: This study documents high variability in the accuracy and utility of a wristband sensor to track nutritional intake, highlighting the need for reliable, effective measurement tools to facilitate accurate, precision-based technologies for personal dietary guidance and intervention. ",
doi="10.2196/16405",
url="https://mhealth.jmir.org/2020/7/e16405",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706729"
}


@Article{info:doi/10.2196/15948,
author="Elliston, G. Katherine
and Sch{\"u}z, Benjamin
and Albion, Tim
and Ferguson, G. Stuart",
title="Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e15948",
keywords="ecological momentary assessment",
keywords="mHealth",
keywords="geographic information systems",
keywords="food intake",
keywords="mobile phone",
abstract="Background: It has been observed that eating is influenced by the presence and availability of food. Being aware of the presence of food in the environment may enable mobile health (mHealth) apps to use geofencing techniques to determine the most appropriate time to proactively deliver interventions. To date, however, studies on eating typically rely on self-reports of environmental contexts, which may not be accurate or feasible for issuing mHealth interventions. Objective: This study aimed to compare the subjective and geographic information system (GIS) assessments of the momentary food environment to explore the feasibility of using GIS data to predict eating behavior and inform geofenced interventions. Methods: In total, 72 participants recorded their food intake in real-time for 14 days using an ecological momentary assessment approach. Participants logged their food intake and responded to approximately 5 randomly timed assessments each day. During each assessment, the participants reported the number and type of food outlets nearby. Their electronic diaries simultaneously recorded their GPS coordinates. The GPS data were later overlaid with a GIS map of food outlets to produce an objective count of the number of food outlets within 50 m of the participant. Results: Correlations between self-reported and GIS counts of food outlets within 50 m were only of a small size (r=0.17; P<.001). Logistic regression analyses revealed that the GIS count significantly predicted eating similar to the self-reported counts (area under the curve for the receiver operating characteristic curve [AUC-ROC] self-report=0.53, SE 0.00 versus AUC-ROC 50 m GIS=0.53, SE 0.00; P=.41). However, there was a significant difference between the GIS-derived and self-reported counts of food outlets and the self-reported type of food outlets (AUC-ROC self-reported outlet type=0.56, SE 0.01; P<.001). Conclusions: The subjective food environment appears to predict eating better than objectively measured food environments via GIS. mHealth apps may need to consider the type of food outlets rather than the raw number of outlets in an individual's environment. ",
doi="10.2196/15948",
url="https://mhealth.jmir.org/2020/7/e15948",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706728"
}


@Article{info:doi/10.2196/18068,
author="Meinert, Edward
and Rahman, Em
and Potter, Alison
and Lawrence, Wendy
and Van Velthoven, Michelle",
title="Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="22",
volume="9",
number="7",
pages="e18068",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="digital technology",
keywords="weight loss",
keywords="obesity",
keywords="overweight",
keywords="child health",
keywords="cell phone",
keywords="telecommunication",
abstract="Background: Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care's national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity. Objective: This feasibility study assesses the usability and acceptability of Health Education England's NoObesity app for undertaking activities to improve families' diet and physical activity. The purpose of the study is to evaluate the app's influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. Methods: The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants. Results: This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021. Conclusions: This study will provide evidence on the NoObesity app's influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. International Registered Report Identifier (IRRID): PRR1-10.2196/18068 ",
doi="10.2196/18068",
url="http://www.researchprotocols.org/2020/7/e18068/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706703"
}


@Article{info:doi/10.2196/14778,
author="Langlet, Billy
and Maramis, Christos
and Diou, Christos
and Maglaveras, Nikolaos
and Fagerberg, Petter
and Heimeier, Rachel
and Lekka, Irini
and Delopoulos, Anastasios
and Ioakimidis, Ioannis",
title="Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="21",
volume="8",
number="7",
pages="e14778",
keywords="mHealth",
keywords="eHealth",
keywords="dietary behavior",
keywords="lifestyle behavioral monitoring",
keywords="lifestyle interventions",
keywords="obesity",
keywords="mobile phone",
keywords="smartphone",
keywords="weight management",
keywords="overweight",
abstract="Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the ``mHealth evidence reporting and assessment checklist,'' and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100\% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a `Good' grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70\% the first week to 76\% the second week. Participants reported that 40\% of the registered meals were home-prepared, while 34\% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. ",
doi="10.2196/14778",
url="http://mhealth.jmir.org/2020/7/e14778/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706684"
}


@Article{info:doi/10.2196/18059,
author="Vuorinen, Anna-Leena
and Erkkola, Maijaliisa
and Fogelholm, Mikael
and Kinnunen, Satu
and Saarij{\"a}rvi, Hannu
and Uusitalo, Liisa
and N{\"a}ppil{\"a}, Turkka
and Nevalainen, Jaakko",
title="Characterization and Correction of Bias Due to Nonparticipation and the Degree of Loyalty in Large-Scale Finnish Loyalty Card Data on Grocery Purchases: Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="15",
volume="22",
number="7",
pages="e18059",
keywords="loyalty card data",
keywords="diet",
keywords="selection bias",
keywords="weighting",
keywords="raking",
keywords="food",
abstract="Background: To date, the evaluation of diet has mostly been based on questionnaires and diaries that have their limitations in terms of being time and resource intensive, and a tendency toward social desirability. Loyalty card data obtained in retailing provides timely and objective information on diet-related behaviors. In Finland, the market is highly concentrated, which provides a unique opportunity to investigate diet through grocery purchases. Objective: The aims of this study were as follows: (1) to investigate and quantify the selection bias in large-scale (n=47,066) loyalty card (LoCard) data and correct the bias by developing weighting schemes and (2) to investigate how the degree of loyalty relates to food purchases. Methods: Members of a loyalty card program from a large retailer in Finland were contacted via email and invited to take part in the study, which involved consenting to the release of their grocery purchase data for research purposes. Participants' sociodemographic background was obtained through a web-based questionnaire and was compared to that of the general Finnish adult population obtained via Statistics Finland. To match the distributions of sociodemographic variables, poststratification weights were constructed by using the raking method. The degree of loyalty was self-estimated on a 5-point rating scale. Results: On comparing our study sample with the general Finnish adult population, in our sample, there were more women (65.25\%, 30,696/47,045 vs 51.12\%, 2,273,139/4,446,869), individuals with higher education (56.91\%, 20,684/36,348 vs 32.21\%, 1,432,276/4,446,869), and employed individuals (60.53\%, 22,086/36,487 vs 52.35\%, 2,327,730/4,446,869). Additionally, in our sample, there was underrepresentation of individuals aged under 30 years (14.44\%, 6,791/47,045 vs 18.04\%,  802,295/4,446,869) and over 70 years (7.94\%, 3,735/47,045 vs  18.20\%, 809,317/4,446,869), as well as retired individuals (23.51\%, 8,578/36,487 vs 31.82\%, 1,414,785/4,446,869). Food purchases differed by the degree of loyalty, with higher shares of vegetable, red meat \& processed meat, and fat spread purchases in the higher loyalty groups. Conclusions: Individuals who consented to the use of their loyalty card data for research purposes tended to diverge from the general Finnish adult population. However, the high volume of data enabled the inclusion of sociodemographically diverse subgroups and successful correction of the differences found in the distributions of sociodemographic variables. In addition, it seems that food purchases differ according to the degree of loyalty, which should be taken into account when researching loyalty card data. Despite the limitations, loyalty card data provide a cost-effective approach to reach large groups of people, including hard-to-reach population subgroups. ",
doi="10.2196/18059",
url="http://www.jmir.org/2020/7/e18059/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459633"
}


@Article{info:doi/10.2196/15726,
author="Cairns, Patrick
and Ozakinci, Gozde
and Perrett, Ian David",
title="Reactions to an Online Demonstration of the Effect of Increased Fruit and Vegetable Consumption on Appearance: Survey Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="14",
volume="22",
number="7",
pages="e15726",
keywords="diet",
keywords="skin appearance",
keywords="motivations",
keywords="fruit and vegetables",
keywords="carotenoid",
abstract="Background: Inadequate fruit and vegetable consumption causes a considerable disease burden and premature mortality. Despite public health promotion of a healthy diet, the average consumption is still below recommended levels. Fruit and vegetable consumption influences human skin color, increasing red/yellow/orange pigment in the skin. Given that this color is deemed attractive and healthy-looking, the appearance benefit may motivate to eat more fruit and vegetables. Such appearance motivation could be particularly useful in young individuals who currently eat the least fruit and vegetables. Objective: Our objectives were to assess how widely the impact of diet on skin color is known within the UK and to compare the strength of motivation to eat fruit and vegetables based on health and appearance benefits among different demographic groups. Methods: Four groups of UK residents (N=200 per group) were recruited through the Prolific online platform. Groups comprised younger (aged 18-24) and older adults (aged 40-60) of low and high self-reported socioeconomic status (1-5 and 6-10 on a 10-point rating scale). Facial images simulating the skin color associated with low and high fruit and vegetable diets were shown to participants. Questionnaires were used to assess (1) background knowledge of the health and skin color effects of dietary fruit and vegetables, (2) the specific motivational impact of the skin color illustration, and (3) the relative importance of motivation to consume fruit and vegetables arising from health and skin color appearance benefits. Results: We found that 61\% (n=487) of all participants were unaware of the dietary--skin color association. We also found that 57\% (n=457) of participants found the simple demonstration of the dietary impact on skin color positively motivating to eat more fruit and vegetables. The visual demonstration was equally motivating for participants of high and low self-reported socioeconomic status (P=.63) and different ethnic backgrounds (White N=453, Black N=182, Asian N=87, P=.22). Health benefits from a diet high in fruit and vegetables were regarded as more motivating than skin color appearance benefits. The appearance-changing benefits of a high fruit and vegetable diet (compared to the health benefits) were relatively more important for the younger participants (Mann-Whitney U=96,263, P<.001) and for women (N=489) than for men (N=310, U=83,763, P=.01). Conclusions: These findings indicate that the promotion of the skin color effects of diets high in fruit and vegetables could provide additional motivation for a healthier diet. Our study indicates the broad appeal of appearance benefits from dietary fruit and vegetable (across ethnicity and socioeconomic status) and particularly amongst young adults where an inadequate diet is most prevalent. ",
doi="10.2196/15726",
url="https://www.jmir.org/2020/7/e15726",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459626"
}


@Article{info:doi/10.2196/18255,
author="Rhodes, Alexandra
and Smith, D. Andrea
and Chadwick, Paul
and Croker, Helen
and Llewellyn, H. Clare",
title="Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="10",
volume="8",
number="7",
pages="e18255",
keywords="gestational weight gain",
keywords="digital interventions",
keywords="behavior change techniques",
keywords="user engagement",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. Objective: This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. Methods: A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. Results: In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (?0.28 kg; 95\% CI ?1.43 to 0.87) or per-protocol data (?0.65 kg; 95\% CI ?1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. Conclusions: In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness. ",
doi="10.2196/18255",
url="https://mhealth.jmir.org/2020/7/e18255",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673251"
}


@Article{info:doi/10.2196/17558,
author="Maher, Ann Carol
and Davis, Rose Courtney
and Curtis, Grace Rachel
and Short, Elizabeth Camille
and Murphy, Joy Karen",
title="A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="10",
volume="8",
number="7",
pages="e17558",
keywords="virtual assistant",
keywords="chatbot",
keywords="Mediterranean diet",
keywords="physical activity",
keywords="lifestyle",
abstract="Background: Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale. Objective: This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach. Methods: This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure. Results: Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95\% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95\% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95\% CI --0.1 to --2.5 kg) and 2.1 cm from their waist circumference (95\% CI --3.5 to --0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90\% at 12 weeks), and safety (no adverse events). Conclusions: An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted. ",
doi="10.2196/17558",
url="https://mhealth.jmir.org/2020/7/e17558",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673246"
}


@Article{info:doi/10.2196/16083,
author="Thilsing, Trine
and Sonderlund, Larrabee Anders
and Sondergaard, Jens
and Svensson, Herning Nanna
and Christensen, Reffstrup Jeanette
and Thomsen, Laust Janus
and Hvidt, Christian Niels
and Larsen, Bruun Lars",
title="Changes in Health-Risk Behavior, Body Mass Index, Mental Well-Being, and Risk Status Following Participation in a Stepwise Web-Based and Face-to-Face Intervention for Prevention of Lifestyle-Related Diseases: Nonrandomized Follow-Up Cohort Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Jul",
day="9",
volume="6",
number="3",
pages="e16083",
keywords="health behavior",
keywords="noncommunicable diseases",
keywords="lifestyle-related disease",
keywords="prevention",
keywords="patient web portal",
keywords="primary health care",
keywords="risk reduction behavior",
abstract="Background: Recent evidence suggests the effectiveness of stepwise, targeted approaches for the prevention of lifestyle-related diseases with combinations of web-based and face-to-face interventions showing promising results. Objective: This paper reports on 1-year changes in health-risk behaviors, BMI, self-rated health, mental well-being, and risk of disease at 1-year follow-up after participation in a stepwise intervention that targeted persons at high risk of disease and persons with health-risk behavior. To this end, we distinguish between participants who took up the full intervention (web-based plus face-to-face) and those who received only the web-based intervention. Methods: The Early Detection and Prevention (Danish acronym: TOF) pilot study was conducted as a nonrandomized, 1-year follow-up intervention study in two municipalities in the Region of Southern Denmark. A total of 9400 citizens born between 1957 and 1986 (aged 29 to 60 years) were randomly sampled from participating general practitioner (GP) patient-list systems and were invited to take part in the study. Participants were subsequently stratified into risk groups based on their responses to a questionnaire on health-risk behavior and data from their GP's electronic patient record (EPR) system. All participants received a digital personal health profile with individualized information on current health-risk behavior and targeted advice on relevant health-risk behavior changes. In addition, patients at high risk of disease, as indicated by their digital health profile, were offered a targeted intervention at their GP. Patients who were not deemed at high risk of disease but who exhibited health-risk behaviors were offered a targeted intervention at their municipal health center (MHC). At 1-year follow-up, health-risk behaviors, self-rated health, BMI, and mental well-being were reassessed by questionnaire, and current information on diagnoses and medical treatment was retrieved from the EPRs. Results: Of 598 patients at high risk of disease or with health-risk behavior, 135 took up the targeted intervention at their GP or MHC and 463 received the personal health profile only. From baseline to 1-year follow-up, the number of patients with unhealthy eating habits decreased, mean mental well-being increased, and smoking prevalence decreased in patients who had received the digital personal health profile alone. Among patients who took up the targeted intervention, unhealthy eating habits and sedentary lifestyles decreased and significant reductions in mean BMI were observed. At 1-year follow up, no health-risk behaviors were detected among 17.4\% of patients who at baseline had exhibited health-risk behaviors or high risk of disease. Conclusions: A stepwise targeted preventive approach using web-based and face-to-face elements may lead to favorable lifestyle changes. Specifically, a web-based approach may improve smoking and eating habits and mental well-being, whereas supplementary face-to-face interventions may be necessary to improve exercise habits and BMI. Trial Registration: ClinicalTrials.gov NCT02797392; https://clinicaltrials.gov/ct2/show/NCT02797392 International Registered Report Identifier (IRRID): RR2-10.1186/s12875-018-0820-8 ",
doi="10.2196/16083",
url="https://publichealth.jmir.org/2020/3/e16083",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673269"
}


@Article{info:doi/10.2196/17702,
author="Mesman, Mathijs
and Onrust, Simone
and Verkerk, Ren{\'e}e
and Hendriks, Hanneke
and Van den Putte, Bas",
title="Effectiveness of the InCharge Prevention Program to Promote Healthier Lifestyles: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="8",
volume="9",
number="7",
pages="e17702",
keywords="school-based health intervention",
keywords="adolescents",
keywords="health behavior",
keywords="healthy lifestyle",
keywords="quality of life",
keywords="behavior change",
abstract="Background: InCharge is a newly developed school-based health intervention aimed at older adolescents. It aims to promote a healthier lifestyle by increasing self-regulation skills. After the InCharge program's effectiveness was previously investigated in a pilot study, the content of the program was adapted. Objective: This study describes the protocol of a cluster randomized controlled trial that aims to investigate the effectiveness of the InCharge program. Methods: A cluster randomized controlled trial including 70 classes with older adolescents (aged 16 years or older) in the Netherlands will be conducted to test the effectiveness of the InCharge program. After schools are recruited, randomization occurs at the class level. The trial consists of the following two conditions: an experimental condition and a control condition. Participants in the experimental condition will be given the InCharge intervention, consisting of four lessons of 50 minutes, with each lesson containing three assignments of approximately 15 minutes. While participants in the experimental condition will receive InCharge, participants in the control condition will receive regular academic school courses. Surveys are administered 1 week before the intervention (baseline), 1 week after the intervention (posttest), and 12 weeks after the intervention (follow-up). Variables of interest include, but are not limited to, self-regulation; predictors of snack intake, physical activity, and alcohol use; and interpersonal communication regarding these health behaviors. In addition to surveys, observations will be conducted during the first and fourth lessons, teachers will be interviewed, and focus groups will be held with a selection of students from the intervention condition. Results: Enrollment started in September 2017. As of June 2019, a total of 1216 participants were enrolled for this trial. Findings will be published in peer-reviewed journals and presented at conferences. The trial has been approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences of the University of Amsterdam (reference no.: 2017-PC-8244). Conclusions: In this study protocol, the design of a cluster randomized controlled trial is described, which assesses how effectively the school-based intervention InCharge stimulates healthier lifestyles in late adolescents. We hypothesize that participants in the experimental condition will consume less alcohol, eat fewer unhealthy snacks, and be more physically active compared with participants in the control condition. Trial Registration: Netherlands Trial Register (NL6654); https://www.trialregister.nl/trial/6654 International Registered Report Identifier (IRRID): RR1-10.2196/17702 ",
doi="10.2196/17702",
url="http://www.researchprotocols.org/2020/7/e17702/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673278"
}


@Article{info:doi/10.2196/18391,
author="LeRouge, M. Cynthia
and Hah, Hyeyoung
and Deckard, J. Gloria
and Jiang, Haoqiang",
title="Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="29",
volume="8",
number="6",
pages="e18391",
keywords="consumer health technologies",
keywords="obesity care model",
keywords="chronic care model",
keywords="UTAUT",
keywords="qualitative research",
keywords="overweight",
keywords="mobile phone",
keywords="adolescent",
keywords="couse",
keywords="social support",
keywords="obesity",
keywords="social influence",
keywords="consumer health informatics",
abstract="Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents' intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. ",
doi="10.2196/18391",
url="http://mhealth.jmir.org/2020/6/e18391/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32597788"
}


@Article{info:doi/10.2196/17845,
author="Willcox, C. Jane
and Chai, Daniel
and Beilin, J. Lawrence
and Prescott, L. Susan
and Silva, Desiree
and Neppe, Cliff
and Huang, Rae-Chi",
title="Evaluating Engagement in a Digital and Dietetic Intervention Promoting Healthy Weight Gain in Pregnancy: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="26",
volume="22",
number="6",
pages="e17845",
keywords="pregnancy",
keywords="internet-based intervention",
keywords="patient participation",
keywords="qualitative research",
keywords="eHealth",
keywords="body weight",
keywords="obesity",
abstract="Background: Early excess and inadequate gestational weight gain (GWG) have been associated with negative outcomes for mother and child. The use of digital media to deliver pregnancy lifestyle interventions is increasing, but there is little data on participant engagement. The Pregnancy Lifestyle Activity and Nutrition (PLAN) intervention pilot study was an electronic health and dietetic-delivered intervention program promoting healthy GWG in early pregnancy. Objective: This study aims to explore the interactions of participants with the program and to assess its acceptability. Methods: This study uses both quantitative and qualitative methods using data from parent randomized controlled trial (ACTRN12617000725369). Quantitative data from 22 participants in the intervention arm who completed the study provided measures of the interactions participants had with the digital components of the program and with dietetic consultations. A descriptive qualitative analysis employed semistructured interviews with 9 participants to elicit views on the acceptability of the intervention and its components. Results: The electronic delivery of information and recording of weight from 8 to 20 weeks of gestation were universally accepted. Component (face-to-face dietitian, weight tracker, website information delivery, and SMS goal prompting) acceptability and engagement differed between individuals. A total of 4 key themes emerged from the qualitative analysis: supporting lifestyle change, component acceptability and value, delivery platforms, and engagement barriers. Conclusions: The PLAN intervention and its delivery via a blend of personal dietetic consultations and digital program delivery was found to be acceptable and valuable to pregnant women. Individuals responded differently to various components, emphasizing the importance of including women in the development of lifestyle interventions and allowing participants to choose and tailor programs. Larger randomized controlled trials using these insights in a broader section of the community are needed to inform the iterative development of practical, time-efficient, and cost-effective ways of supporting optimal GWG with the potential to optimize outcomes for pregnant women and their child. ",
doi="10.2196/17845",
url="http://www.jmir.org/2020/6/e17845/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442153"
}


@Article{info:doi/10.2196/15930,
author="Tang, K. Hong
and Nguyen, Ngoc-Minh
and Dibley, J. Michael
and Nguyen, D. Trang H. H.
and Alam, Ashraful",
title="Improving the Lifestyle of Adolescents Through Peer Education and Support in Vietnam: Protocol for a Pilot Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Jun",
day="26",
volume="9",
number="6",
pages="e15930",
keywords="peer education",
keywords="peer support",
keywords="peer leader",
keywords="adolescents",
keywords="dietary behaviors",
keywords="physical activity",
keywords="Vietnam",
abstract="Background: In Ho Chi Minh City, Vietnam, recent studies found a rapid increase in overweight and obesity in adolescents. There is a need for effective health promotion interventions to support healthy diets and encourage a physically active lifestyle. This study will help fill an evidence gap on effective interventions to prevent excess weight gain in adolescents and generate new insights about peer-led education to promote healthy lifestyles. Objective: We aim to assess the feasibility and acceptability of a combined peer-led and peer support intervention among junior high school students in Ho Chi Minh City. Additionally, the efficacy of the intervention on adolescents' dietary practices and time spent on physical activity will also be measured in this pilot study. Methods: The Peer Education and Peer Support (PEPS) project is a pilot cluster randomized controlled trial with 2 intervention and 2 control schools. The intervention consists of 4 weekly education sessions of why and how to choose healthy food and drinks and how to be more physically active. Additionally, the intervention includes a school-based and online support system to help maintain student engagement during the intervention. We will use in-depth interviews with students, peer leaders, teachers, and parents; focus group discussions with peer educators; and direct observation of the school environment and peer leaders' interactions with the students. Acceptability and feasibility of the intervention will be assessed. We will also quantitatively assess limited efficacy by measuring changes in student' physical activity levels and dietary behaviors. Results: We delivered the peer education intervention at the start of each school year over 3 months for all new grade 6 adolescents in the selected schools, followed by peer support and home engagement activities over 6 months until the end of the school year. There was a baseline assessment and 2 post-intervention assessments: the first immediately after the intervention to assess the short-term impact and the second at the end of the school year to assess the sustained impact on changes in adiposity, diet, and physical activity. Conclusions: The findings of this study will be used to develop a larger-scale cluster randomized controlled trial to examine the impact of a multicomponent, school- and home-based health promotion intervention. The trial will use innovative peer education methods to reduce overweight and obesity and improve dietary choices and physical activity levels in Vietnamese adolescents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000421134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376690\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/15930 ",
doi="10.2196/15930",
url="http://www.researchprotocols.org/2020/6/e15930/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32589155"
}


@Article{info:doi/10.2196/19172,
author="Brandt, J. Carl
and Christensen, Reffstrup Jeanette
and Lauridsen, T. J{\o}rgen
and Nielsen, Bo Jesper
and S{\o}ndergaard, Jens
and Sorts{\o}, Camilla",
title="Evaluation of the Clinical and Economic Effects of a Primary Care Anchored, Collaborative, Electronic Health Lifestyle Coaching Program in Denmark: Protocol for a Two-Year Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Jun",
day="25",
volume="9",
number="6",
pages="e19172",
keywords="type 2 diabetes management",
keywords="digital behavioral coaching",
keywords="lifestyle change",
keywords="health behavior change",
keywords="obesity",
keywords="weight loss",
keywords="interactive advice",
keywords="participant engagement",
keywords="quality of life",
abstract="Background: Obesity is linked to a number of chronic health conditions, such as type 2 diabetes, heart disease, and cancer, and weight loss interventions are often expensive. Recent systematic reviews concluded that app and web-based interventions can improve lifestyle behaviors and weight loss at a reasonable cost, but long-term sustainability needs to be demonstrated. Objective: This study protocol is for a 2-year randomized controlled trial that aims to evaluate the clinical and economic effects of a primary care, anchored, collaborative, electronic health (eHealth) lifestyle coaching program (long-term Lifestyle change InterVention and eHealth Application [LIVA] 2.0) in obese participants with and without type 2 diabetes. The program's primary outcome is weight loss. Its secondary outcome is the hemoglobin A1c (HbA1c) level, and its tertiary outcomes are retention rate, quality of life (QOL), and cost effectiveness. Analytically, the focus is on associations of participant characteristics with outcomes and sustainability. Methods: We conduct a multicenter trial with a 1-year intervention and 1-year retention. LIVA 2.0 is implemented in municipalities within administrative regions in Denmark, specifically eight municipalities located within the Region of Southern Denmark and two municipalities located within the Capital Region of Denmark. The participants are assessed at baseline and at 6-, 12-, and 24-month follow-ups. Individual data from the LIVA 2.0 platform are combined with clinical measurements, questionnaires, and participants' usage of municipality and health care services. The participants have a BMI ?30 but ?45 kg/m2, and 50\% of the participants have type 2 diabetes. The participants are randomized in an approximately 60:40 manner, and based on sample size calculations on weight loss and intention-to-treat statistics, 200 participants are randomized to an intervention group and 140 are randomized to a control group. The control group is offered the conventional preventive program of the municipality, and it is compared to the intervention group, which follows the LIVA 2.0 in addition to the conventional preventive program. Results: The first baseline assessments have been carried out in March 2018, and the 2-year follow-up will be carried out between March 2020 and April 2021. The hypothesis is that the trial results will demonstrate decreased body weight and that the number of patients who show normalization of their HbA1c levels in the intervention group will be much higher than that in the control group. The participants in the intervention group are also expected to show a greater decrease in their use of glucose-lowering medication and a greater improvement in their QOL when compared with the control group. Operational costs are expected to be lower than standard care, and the intervention is expected to be cost-effective. Conclusions: This is the first time that an app and web-based eHealth lifestyle coaching program implemented in Danish municipalities will be clinically and economically evaluated. If the LIVA 2.0 eHealth lifestyle coaching program is proven to be effective, there is great potential for decreasing the rates of obesity, diabetes, and related chronic diseases. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 International Registered Report Identifier (IRRID): DERR1-10.2196/19172 ",
doi="10.2196/19172",
url="http://www.researchprotocols.org/2020/6/e19172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32584260"
}


@Article{info:doi/10.2196/15478,
author="Ritchie, D. Natalie
and Guti{\'e}rrez-Raghunath, Silvia
and Durfee, Josh Michael
and Fischer, Henry",
title="Supplemental Text Message Support With the National Diabetes Prevention Program: Pragmatic Comparative Effectiveness Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="18",
volume="8",
number="6",
pages="e15478",
keywords="eHealth",
keywords="prediabetes",
keywords="texting",
keywords="weight loss",
abstract="Background: The evidence-based National Diabetes Prevention Program (NDPP) is now widely disseminated, yet strategies to increase its effectiveness are needed, especially for underserved populations. The yearlong program promotes lifestyle changes for weight loss and can be offered in-person, online, via distance learning, or a combination of modalities. Less is known about which delivery features are optimal and may help address disparities in outcomes for subgroups. We previously demonstrated the efficacy of a stand-alone text messaging intervention based on the NDPP (SMS4PreDM) in a randomized controlled trial in a safety net health care system. Upon broader dissemination, we then showed that SMS4PreDM demonstrated high retention and modest weight loss at a relatively low cost, suggesting the potential to improve in-person NDPP delivery. Objective: In this study, we aim to compare the effectiveness of in-person NDPP classes with and without supplementary SMS4PreDM on attendance and weight loss outcomes to determine whether text messaging can enhance in-person NDPP delivery for a safety net patient population. Methods: From 2015 to 2017, patients with diabetes risks were identified primarily from provider referrals and enrolled in NDPP classes, SMS4PreDM, or both per their preference and availability. Participants naturally formed three groups: in-person NDPP with SMS4PreDM (n=236), in-person NDPP alone (n=252), and SMS4PreDM alone (n=285). This analysis compares the first two groups to evaluate whether supplemental text messaging may improve in-person NDPP outcomes. Outcomes for SMS4PreDM-only participants were previously reported. NDPP classes followed standard delivery guidelines, including weekly-to-monthly classes over a year. SMS4PreDM delivery included messages promoting lifestyle change and modest weight loss, sent 6 days per week for 12 months. Differences in characteristics between intervention groups were assessed using chi-square and t tests. Differences in NDPP attendance and weight loss outcomes were analyzed with multivariable linear and logistic regressions. Results: The mean age was 50.4 years (SD 13.9). Out of a total of 488 participants, 76.2\% (n=372) were female and 59.0\% (n=288) were Hispanic. An additional 17.2\% (n=84) were non-Hispanic white and 12.9\% (n=63) were non-Hispanic black. A total of 48.4\% (n=236) of participants elected to receive supplemental text message support in addition to NDPP classes. Participants who chose supplemental text message support were on average 5.7 (SD 1.2) years younger (P<.001) than the 252 participants who preferred in-person classes alone. Relatively more women and Hispanic individuals enrolled in the NDPP with supplemental text messages than in NDPP classes alone, 83.9\% (n=198) vs 69.0\% (n=174, P<.001) and 68.6\% (n=162) vs 50.0\%  (n=126, P=.001), respectively. Attendance and weight loss outcomes were comparable between groups. Conclusions: Despite its appeal among priority populations, supplemental text messaging did not significantly increase attendance and weight loss for the in-person NDPP. Further research is needed to identify optimal strategies to improve the effectiveness of the NDPP. ",
doi="10.2196/15478",
url="http://mhealth.jmir.org/2020/6/e15478/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32554385"
}


@Article{info:doi/10.2196/17640,
author="Hsu, Wan-Chen
and Chiang, Chia-Hsun",
title="Effect of BMI and Perceived Importance of Health on the Health Behavior of College Students: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="11",
volume="22",
number="6",
pages="e17640",
keywords="body mass index",
keywords="college students",
keywords="health behavior",
keywords="perceived importance of health",
abstract="Background: Both body mass index (BMI) and the perceived importance of health have received a lot of attention, but few studies have fully investigated the interaction of their effects on health behaviors. Objective: This study investigates the effects of BMI and the perceived importance of health on health behaviors (patterns of eating, sleeping, and exercising) among college students in Taiwan. Methods: A survey was conducted with 334 students to assess their perception of the importance of health (using indicators) and their health behavior (using the Health Behaviors Scale). Respondent BMI was calculated from self-reported body weight and height. Descriptive statistical analysis, independent t test analysis, two-way analysis of variance (ANOVA), and one-way ANOVA were conducted. Results: The results showed a significant difference between genders in health behaviors among college students (eating: t332=2.17, P=.03; exercise: t332=5.57, P<.001; sleep: t332=2.58, P=.01). Moreover, there was an interaction between BMI and perception (of the importance of health) for exercise behaviors (F2,328=3.50, P=.03), but not for eating behaviors (F2,328=0.12, P=.89) or sleep behaviors (F2,328=1.64, P=.20). Conclusions: This study establishes, for the first time, the interaction of BMI and the perceived importance of health on health behaviors. The perception of health was found to have a significant effect on exercise behaviors. Thus, the perception of health plays a significant role in the exercise behaviors of college students in Taiwan. This finding provides researchers, policy makers, and practitioners with evidence, and consequently, opportunities for focusing on preventive actions. The findings suggest that increasing the importance of health in the perception of college students, should be the focus of efforts to help students exercise more regularly. ",
doi="10.2196/17640",
url="https://www.jmir.org/2020/6/e17640",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525487"
}


@Article{info:doi/10.2196/17014,
author="Tariq, Amina
and Khan, R. Shanchita
and Basharat, Amna",
title="Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="10",
volume="22",
number="6",
pages="e17014",
keywords="internet",
keywords="digital health",
keywords="eHealth",
keywords="eHealth literacy",
keywords="internet use",
keywords="physical activity",
keywords="university students",
keywords="Pakistan",
abstract="Background: Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy---the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision---is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries. Objective: The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non--health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake. Methods: Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1\%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P?.05 was considered significant. Results: In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4\%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants. Conclusions: University students in non--health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries. ",
doi="10.2196/17014",
url="http://www.jmir.org/2020/6/e17014/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32519974"
}


@Article{info:doi/10.2196/16165,
author="Giorgi Rossi, Paolo
and Ferrari, Francesca
and Amarri, Sergio
and Bassi, Andrea
and Bonvicini, Laura
and Dall'Aglio, Luca
and Della Giustina, Claudia
and Fabbri, Alessandra
and Ferrari, Maria Anna
and Ferrari, Elena
and Fontana, Marta
and Foracchia, Marco
and Gallelli, Teresa
and Ganugi, Giulia
and Ilari, Barbara
and Lo Scocco, Sara
and Maestri, Gianluca
and Moretti, Veronica
and Panza, Costantino
and Pinotti, Mirco
and Prandini, Riccardo
and Storani, Simone
and Street, Elisabeth Maria
and Tamelli, Marco
and Trowbridge, Hayley
and Venturelli, Francesco
and Volta, Alessandro
and Davoli, Maria Anna
and ",
title="Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="8",
volume="8",
number="6",
pages="e16165",
keywords="childhood obesity",
keywords="health promotion",
keywords="mHealth",
keywords="cocreation",
keywords="mobile app",
abstract="Background: Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective: The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents' phones aimed at promoting child health and preventing obesity. Methods: After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results: Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children's need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions: The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project. ",
doi="10.2196/16165",
url="https://mhealth.jmir.org/2020/6/e16165",
url="http://www.ncbi.nlm.nih.gov/pubmed/32357123"
}


@Article{info:doi/10.2196/13745,
author="Liu, Yang
and Yin, Zhijun",
title="Understanding Weight Loss via Online Discussions: Content Analysis of Reddit Posts Using Topic Modeling and Word Clustering Techniques",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="8",
volume="22",
number="6",
pages="e13745",
keywords="weight loss",
keywords="online health community",
keywords="machine learning",
keywords="topic modeling",
keywords="word2vec",
keywords="hierarchical clustering",
keywords="consumer health",
abstract="Background: Maintaining a healthy weight can reduce the risk of developing many diseases, including type 2 diabetes, hypertension, and certain types of cancers. Online social media platforms are popular among people seeking social support regarding weight loss and sharing their weight loss experiences, which provides opportunities for learning about weight loss behaviors. Objective: This study aimed to investigate the extent to which the content posted by users in the r/loseit subreddit, an online community for discussing weight loss, and online interactions were associated with their weight loss in terms of the number of replies and votes that these users received. Methods: All posts that were published before January 2018 in r/loseit were collected. We focused on users who revealed their start weight, current weight, and goal weight and were active in this online community for at least 30 days. A topic modeling technique and a hierarchical clustering algorithm were used to obtain both global topics and local word semantic clusters. Finally, we used a regression model to learn the association between weight loss and topics, word semantic clusters, and online interactions. Results: Our data comprised 477,904 posts that were published by 7660 users within a span of 7 years. We identified 25 topics, including food and drinks, calories, exercises, family members and friends, and communication. Our results showed that the start weight ($\beta$=.823; P<.001), active days ($\beta$=.017; P=.009), and median number of votes ($\beta$=.263; P=.02), mentions of exercises ($\beta$=.145; P<.001), and nutrition ($\beta$=.120; P<.001) were associated with higher weight loss. Users who lost more weight might be motivated by the negative emotions ($\beta$=?.098; P<.001) that they experienced before starting the journey of weight loss. In contrast, users who mentioned vacations ($\beta$=?.108; P=.005) and payments ($\beta$=?.112; P=.001) tended to experience relatively less weight loss. Mentions of family members ($\beta$=?.031; P=.03) and employment status ($\beta$=?.041; P=.03) were associated with less weight loss as well. Conclusions: Our study showed that both online interactions and offline activities were associated with weight loss, suggesting that future interventions based on existing online platforms should focus on both aspects. Our findings suggest that online personal health data can be used to learn about health-related behaviors effectively. ",
doi="10.2196/13745",
url="https://www.jmir.org/2020/6/e13745",
url="http://www.ncbi.nlm.nih.gov/pubmed/32510460"
}


@Article{info:doi/10.2196/18098,
author="Moore, B. Justin
and Dilley, R. Joshua
and Singletary, R. Camelia
and Skelton, A. Joseph
and Miller Jr, P. David
and Heboyan, Vah{\'e}
and De Leo, Gianluca
and Turner-McGrievy, Gabrielle
and McGrievy, Matthew
and Ip, H. Edward",
title="A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study",
journal="JMIR Res Protoc",
year="2020",
month="Jun",
day="5",
volume="9",
number="6",
pages="e18098",
keywords="physical activity",
keywords="obesity",
keywords="adolescence",
keywords="adult",
keywords="therapy, family",
keywords="mobile phone",
abstract="Background: Severe obesity among youths (BMI for age?120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. Objective: This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. Methods: Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. Results: This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. Conclusions: The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID): PRR1-10.2196/18098 ",
doi="10.2196/18098",
url="https://www.researchprotocols.org/2020/6/e18098",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348291"
}


@Article{info:doi/10.2196/16216,
author="Holzmann, Laura Sophie
and Sch{\"a}fer, Hanna
and Plecher, Alexander David
and Stecher, Lynne
and Klinker, Johanna Gudrun
and Groh, Georg
and Hauner, Hans
and Holzapfel, Christina",
title="Serious Games for Nutritional Education: Online Survey on Preferences, Motives, and Behaviors Among Young Adults at University",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="3",
volume="8",
number="2",
pages="e16216",
keywords="nutrition",
keywords="information sources",
keywords="serious games",
keywords="digital gameplay",
keywords="preferences",
keywords="motives",
keywords="behavior",
keywords="university students",
keywords="survey",
abstract="Background: Data on nutritional information and digital gameplay are limited among young adults in Germany. Objective: This survey aimed to gather data on nutritional information sources and digital games for nutritional education (preferences, motives, and behaviors) among young adults at both Munich universities in Germany. Methods: An online survey was developed by an multidisciplinary research group using EvaSys, an in-house survey software. The questionnaire (47 items) covered questions about baseline characteristics (eg, housing situation and weight), nutrition (eg, nutritional information sources), and digital (nutritional) gameplay (eg, preferences, motives, and behaviors). A feedback field was also provided. This publication is based on a selection of 20 questions (7 baseline characteristics, 2 nutrition, 11 gameplay). Young adults, primarily Munich university students aged from 18 to 24 years, were invited to participate by digital and nondigital communication channels between 2016 and 2017. Statistical analyses were performed using Excel 2013 (Microsoft Corp) and R version 3.1.3 (R Foundation for Statistical Computing). Results: In total, 468 young adults (342/468, 73.1\% women; 379/468, 81.0\% university students) participated. Most of the participants (269/468, 57.5\%) were aged 18 to 24 years with a BMI in the normal weight range (346/447, 77.4\%). Mean body weight was 65.5 [SD 14.0] kg. Most participants reported getting nutritional information from the internet (372/467, 79.7\%) and printed media (298/467, 63.8\%), less than 1.0\% (2/467, 0.4\%) named digital games. Apps (100/461, 21.7\%) and university/workplace (146/461, 31.7\%) were the most desired sources for additional information about nutrition, while 10.0\% (46/461, 10.0\%) of participants stated wanting digital games. Almost two-thirds (293/468, 62.6\%) of participants played digital games, while one-fifth (97/456, 21.3\%) played digital games daily using smartphones or tablets. Finally, most respondents (343/468, 73.3\%), mainly women, expressed interest in obtaining nutritional information during digital gameplay. However, significant gender differences were shown for nutritional acquisition behaviors and digital gameplay preferences, motives, and behaviors. Conclusions: Our survey population reported playing digital games (especially men) and wanting nutritional information during digital gameplay (especially women). Furthermore, university or workplace are named as preferred settings for nutritional information. Therefore, a digital game app might have the potential to be a tool for nutritional education among young adults within the university or workplace environment. ",
doi="10.2196/16216",
url="https://games.jmir.org/2020/2/e16216",
url="http://www.ncbi.nlm.nih.gov/pubmed/32490847"
}


@Article{info:doi/10.2196/17310,
author="Peddie, Meredith
and Ranasinghe, Chaya
and Scott, Tessa
and Heath, Anne-Louise
and Horwath, Caroline
and Gibson, Rosalind
and Brown, Rachel
and Houghton, Lisa
and Haszard, Jillian",
title="Dietary Intake Nutritional Status and Lifestyle of Adolescent Vegetarian and Nonvegetarian Girls in New Zealand (The SuNDiAL Project): Protocol for a Clustered, Cross-Sectional Survey",
journal="JMIR Res Protoc",
year="2020",
month="May",
day="27",
volume="9",
number="5",
pages="e17310",
keywords="vegetarianism",
keywords="teenagers",
keywords="women",
keywords="iron",
keywords="zinc",
keywords="calcium",
keywords="B12",
keywords="physical activity",
keywords="attitudes motivations, beliefs",
abstract="Background: Anecdotally, vegetarian eating patterns seem to be increasing in parallel with growing concerns about environmental sustainability. While this pattern of eating is widely believed to be associated with benefits for the planet and individual health, it may increase the risk of inadequate intakes and nutrient deficiency if not planned carefully. Adolescent girls may be particularly at risk, as they have increased requirements for nutrients such as iron, zinc, calcium, and vitamin B12 during growth and development. Objective: The objective of the SuNDiAL Project (Survey of Nutrition, Dietary Assessment, and Lifestyles) is to compare the dietary intakes and habits, nutrition status, motivations, attitudes, and physical activity of a sample of vegetarian and nonvegetarian adolescent girls in New Zealand. Methods: A clustered, cross-sectional, nationwide study of adolescents aged 15-18 years was conducted. Secondary schools were recruited throughout New Zealand, and pupils (n=290) were invited to participate in data collection in either the first (February to April) or third (August to October) school term of 2019 (New Zealand schools operate on a 4-term year). Sociodemographic and health information; vegetarian status; dietary habits; and attitudes, motivations, and beliefs regarding food choices were assessed via an online self-administered questionnaire. Dietary intakes were collected via two 24-hour diet recalls on nonconsecutive days and will be adjusted for within-person variation using the Multiple Source Method, to represent usual intakes. Nutrient adequacy will be assessed by the estimated average requirement cut-point method or probability approach as appropriate. Height and weight were measured, and blood and urine samples collected for micronutrient status assessment. Participants wore an accelerometer for 7 days to assess 24-hour activity patterns (time spent asleep, sedentary, or engagement in light-intensity or moderate-to-vigorous intensity physical activity). Results: Recruitment and data collection were conducted in 2019. Data are currently being cleaned and analyzed, with publication of the main results anticipated at the end of 2020. Conclusions: The SuNDiAL Project will provide a meaningful and timely description of diet, nutrition status, and motivational factors associated with vegetarianism and identify any risks this pattern of eating may pose for female adolescents. The results of this study will support the development of targeted recommendations and interventions aimed at enhancing the health, growth, and development of adolescent girls. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000290190; https://tinyurl.com/yaumh278 International Registered Report Identifier (IRRID): DERR1-10.2196/17310 ",
doi="10.2196/17310",
url="http://www.researchprotocols.org/2020/5/e17310/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459178"
}


@Article{info:doi/10.2196/15849,
author="Partridge, Ruth Stephanie
and Raeside, Rebecca
and Singleton, Anna
and Hyun, Karice
and Redfern, Julie",
title="Effectiveness of Text Message Interventions for Weight Management in Adolescents: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="26",
volume="8",
number="5",
pages="e15849",
keywords="adolescent",
keywords="text message",
keywords="obesity",
keywords="overweight",
keywords="prevention",
keywords="mHealth",
abstract="Background: The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. Objective: This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. Methods: This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. Results: In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1\% (407/767) female (31/101, 30.7\%-172/172, 100.0\%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50\% (8 studies) and >85\% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3\% to 4.5\% and BMI z-score ranged from 4.2\% to 28.1\%. Overall quality of the studies was low. Conclusions: Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents. ",
doi="10.2196/15849",
url="http://mhealth.jmir.org/2020/5/e15849/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348264"
}


@Article{info:doi/10.2196/15497,
author="Alrige, Mayda
and Alharbey, Riad
and Chatterjee, Samir",
title="The Effect of a Customized Nutrient-Profiling Approach on the Glycated Hemoglobin Levels of Patients With Type 2 Diabetes: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="19",
volume="22",
number="5",
pages="e15497",
keywords="mHealth",
keywords="consumer health informatics",
keywords="diet therapy",
keywords="nutrient profiling",
keywords="Hb A1c",
abstract="Background: Presently, dietary management approaches are mostly oriented toward using calorie-counting and diet-tracking tools that draw our attention away from the nutritional value of our food. To improve individuals' dietary behavior, primarily that of people with type 2 diabetes, a simple technique is needed to increase their understanding of the nutritional content of their food. Objective: This study aimed to design, develop, and evaluate a customized nutrient-profiling tool called EasyNutrition. EasyNutrition was built to introduce the new concept of nutrient profiling by applying the Intelligent Nutrition Engine, an algorithm that we developed for ranking different food recipes based on their nutritional value. This study also aimed to investigate the efficacy of EasyNutrition in lowering glycated hemoglobin (HbA1c) levels and improving dietary habits among people with type 2 diabetes. Methods: We evaluated the utility of EasyNutrition using design science research in three sequential stages. This paper has elaborated on the third stage to investigate the efficacy of EasyNutrition in managing type 2 diabetes. A quasi-experimental study was conducted in a diabetes treatment center (n=28). The intervention group utilized EasyNutrition over 3 months, whereas participants in the control group utilized the standard of care provided by the center. Dietary habits and HbA1c levels were measured to capture any change before and after experimenting with EasyNutrition. Results: The intervention group (n=9) exhibited a statistically significant change between the pre- and postexposure results of their HbA1c (t9=2.427; P=.04). Their HbA1c dropped from 8.13 to 6.72. This provided preliminary evidence of the efficacy of using a customized nutrient-profiling app in reducing HbA1c for people with type 2 diabetes. Conclusions: This study adds to the evidence base that a nutrient-profiling strategy may be a modern adjunct to diabetes dietary management. In conjunction with reliable dietary education provided by a registered dietician, EasyNutrition may have some beneficial effects to improve the dietary habits of people with type 2 diabetes. ",
doi="10.2196/15497",
url="https://www.jmir.org/2020/5/e15497",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427107"
}


@Article{info:doi/10.2196/15773,
author="van Dijk, R. Matthijs
and Koster, H. Maria P.
and Oostingh, C. Elsje
and Willemsen, P. Sten
and Steegers, P. Eric A.
and Steegers-Theunissen, M. R{\'e}gine P.",
title="A Mobile App Lifestyle Intervention to Improve Healthy Nutrition in Women Before and During Early Pregnancy: Single-Center Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="May",
day="15",
volume="22",
number="5",
pages="e15773",
keywords="mHealth",
keywords="preconception care",
keywords="nutrition",
keywords="pregnancy",
abstract="Background: Unhealthy nutrition contributes to the worldwide rising prevalence of noncommunicable diseases. As most adverse reproductive outcomes originate during the periconception period, effective interventions targeting this period are needed. Therefore, we developed the lifestyle intervention Smarter Pregnancy to empower women to adapt a healthy diet prior to conception and during early pregnancy and performed a randomized controlled trial. Objective: The objectives of this trial were to investigate compliance and effectiveness in women using the Smarter Pregnancy program. Methods: Women aged between 18 and 45 years who were contemplating pregnancy or <13 weeks pregnant and their male partners living in the urban area of Rotterdam, the Netherlands, were eligible for participation. After baseline screening, the intervention group received personal online coaching based on identified inadequate intakes of vegetables, fruits, and folic acid supplements. The sum of these risk factors was used as a dietary risk score (DRS), ranging from 0 (healthy) to 9 (unhealthy). The control group did not receive coaching. We applied an intention-to-treat principle and used a multivariable linear regression model to evaluate the change in DRS after 24 weeks. Compliance was defined as the percentage of women who completed the screening questionnaire at 24 weeks. Results: Of women recruited, 81.2\% (177/218) completed the program (intervention: 91/218, 83.5\%; control: 86/218, 78.9\%; P=.95). After 24 weeks, the reduction in DRS of women in the intervention group was significantly larger than in the control group ($\beta$=.75, 95\% CI 0.18-1.34). This reduction was mainly due to increased vegetable intake ($\beta$=.55, 95\% CI 0.25-0.86). Conclusions: The high compliance and the larger improvements in nutritional behaviors, especially vegetable intake, in women in the intervention group emphasizes the effectiveness of empowering women by using the lifestyle change intervention Smarter Pregnancy. Trial Registration: Netherlands Trial Register: NL3927; https://www.trialregister.nl/trial/3927 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-017-1228-5 ",
doi="10.2196/15773",
url="https://www.jmir.org/2020/5/e15773",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412417"
}


@Article{info:doi/10.2196/16297,
author="Pfammatter, Fidler Angela
and Marchese, Hoffman Sara
and Pellegrini, Christine
and Daly, Elyse
and Davidson, Miriam
and Spring, Bonnie",
title="Using the Preparation Phase of the Multiphase Optimization Strategy to Develop a Messaging Component for Weight Loss: Formative and Pilot Research",
journal="JMIR Form Res",
year="2020",
month="May",
day="13",
volume="4",
number="5",
pages="e16297",
keywords="weight loss",
keywords="body weight",
keywords="text messaging",
keywords="optimization",
keywords="automation",
abstract="Background: Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints. Objective: This study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial. Methods: On the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks. Results: Participants (n=9) in the feasibility pilot study lost 3.2\% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss. Conclusions: Following the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial. Trial Registration: ClinicalTrials.gov NCT01814072; https://clinicaltrials.gov/ct2/show/NCT01814072 ",
doi="10.2196/16297",
url="http://formative.jmir.org/2020/5/e16297/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347804"
}


@Article{info:doi/10.2196/13989,
author="Weerahandi, Himali
and Paul, Soaptarshi
and Quintiliani, M. Lisa
and Chokshi, Sara
and Mann, M. Devin",
title="A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study",
journal="JMIR Form Res",
year="2020",
month="May",
day="7",
volume="4",
number="5",
pages="e13989",
keywords="eHealth",
keywords="mobile",
keywords="telemedicine",
abstract="Background: The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective: This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods: We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results: A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60\%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73\%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions: In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes. ",
doi="10.2196/13989",
url="http://formative.jmir.org/2020/5/e13989/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32379049"
}


@Article{info:doi/10.2196/14817,
author="Kim, Meelim
and Kim, Youngin
and Go, Yoonjeong
and Lee, Seokoh
and Na, Myeongjin
and Lee, Younghee
and Choi, Sungwon
and Choi, Jin Hyung",
title="Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e14817",
keywords="obesity",
keywords="digital health care",
keywords="cognitive behavioral therapy",
keywords="mobile phone",
abstract="Background: Developing effective, widely useful, weight management programs is a priority in health care because obesity is a major health problem. Objective: This study developed and investigated a new, comprehensive, multifactorial, daily, intensive, psychologist coaching program based on cognitive behavioral therapy (CBT) modules. The program was delivered via the digital health care mobile services Noom Coach and InBody. Methods: This was an open-label, active-comparator, randomized controlled trial. A total of 70 female participants with BMI scores above 24 kg/m2 and no clinical problems besides obesity were randomized into experimental and control groups. The experimental (ie, digital CBT) group (n=45) was connected with a therapist intervention using a digital health care service that provided daily feedback and assignments for 8 weeks. The control group (n=25) also used the digital health care service, but practiced self-care without therapist intervention. The main outcomes of this study were measured objectively at baseline, 8 weeks, and 24 weeks and included weight (kg) as well as other body compositions. Differences between groups were evaluated using independent t tests and a per-protocol framework. Results: Mean weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (--3.1\%, SD 4.5, vs --0.7\%, SD 3.4, P=.04). Additionally, the proportion of subjects who attained conventional 5\% weight loss from baseline in the digital CBT group was significantly higher than in the control group at 8 weeks (32\% [12/38] vs 4\% [1/21], P=.02) but not at 24 weeks. Mean fat mass reduction in the digital CBT group at 8 weeks was also significantly greater than in the control group (--6.3\%, SD 8.8, vs --0.8\%, SD 8.1, P=.02). Mean leptin and insulin resistance in the digital CBT group at 8 weeks was significantly reduced compared to the control group (--15.8\%, SD 29.9, vs 7.2\%, SD 35.9, P=.01; and --7.1\%, SD 35.1, vs 14.4\%, SD 41.2, P=.04). Emotional eating behavior (ie, mean score) measured by questionnaire (ie, the Dutch Eating Behavior Questionnaire) at 8 weeks was significantly improved compared to the control group (--2.8\%, SD 34.4, vs 21.6\%, SD 56.9, P=.048). Mean snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 kcal, SD 86.4, vs 208.2 kcal, SD 166.3, P=.02). Lastly, baseline depression, anxiety, and self-esteem levels significantly predicted long-term clinical outcomes (24 weeks), while baseline motivation significantly predicted both short-term (8 weeks) and long-term clinical outcomes. Conclusions: These findings confirm that technology-based interventions should be multidimensional and are most effective with human feedback and support. This study is innovative in successfully developing and verifying the effects of a new CBT approach with a multidisciplinary team based on digital technologies rather than standalone technology-based interventions. Trial Registration: ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306 ",
doi="10.2196/14817",
url="http://mhealth.jmir.org/2020/4/e14817/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352391"
}


@Article{info:doi/10.2196/14543,
author="Liu, Ying-Chieh
and Wu, Sheng-Tang
and Lin, Shan-Ju
and Chen, Chien-Hung
and Lin, Yu-Sheng
and Chen, Hsin-Yun",
title="Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e14543",
keywords="portion size measurement",
keywords="prototype",
keywords="user-centered design",
keywords="dietary reporting",
keywords="mobile health",
keywords="randomized controlled trial",
abstract="Background: Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes. Objective: Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in--based aid (KBA), commonly used in many current apps, relies on the user's ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference. Methods: A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed. Results: Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different. Conclusions: Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users' subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750. ",
doi="10.2196/14543",
url="http://mhealth.jmir.org/2020/4/e14543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347805"
}


@Article{info:doi/10.2196/15725,
author="Mack, Isabelle
and Reiband, Nadine
and Etges, Carolin
and Eichhorn, Sabrina
and Schaeffeler, Norbert
and Zurstiege, Guido
and Gawrilow, Caterina
and Weimer, Katja
and Peeraully, Riyad
and Teufel, Martin
and Blumenstock, Gunnar
and Giel, Elisabeth Katrin
and Junne, Florian
and Zipfel, Stephan",
title="The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="24",
volume="22",
number="4",
pages="e15725",
keywords="children",
keywords="serious game",
keywords="nutrition",
keywords="stress",
keywords="energy density",
abstract="Background: Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children. Objective: The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P. Methods: This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6\%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake). Results: The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70\%). Overall, 95\% of the children liked the game very much or much. No group changes were observed at the behavioral level. Conclusions: The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P. Trial Registration: ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978 ",
doi="10.2196/15725",
url="https://www.jmir.org/2020/4/e15725",
url="http://www.ncbi.nlm.nih.gov/pubmed/32329742"
}


@Article{info:doi/10.2196/16386,
author="Brown, Theresa
and Nauman Vogel, Emily
and Adler, Sarah
and Bohon, Cara
and Bullock, Kim
and Nameth, Katherine
and Riva, Giuseppe
and Safer, L. Debra
and Runfola, D. Cristin",
title="Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="23",
volume="22",
number="4",
pages="e16386",
keywords="virtual reality",
keywords="exposure therapy",
keywords="eating disorders",
keywords="translational research",
keywords="technological innovation",
doi="10.2196/16386",
url="http://www.jmir.org/2020/4/e16386/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32324145"
}


@Article{info:doi/10.2196/17816,
author="Ifejika, L. Nneka
and Bhadane, Minal
and Cai, C. Chunyan
and Noser, A. Elizabeth
and Grotta, C. James
and Savitz, I. Sean",
title="Use of a Smartphone-Based Mobile App for Weight Management in Obese Minority Stroke Survivors: Pilot Randomized Controlled Trial With Open Blinded End Point",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e17816",
keywords="smartphone",
keywords="stroke",
keywords="obesity",
keywords="telemedicine",
keywords="minority groups",
keywords="cognitive dysfunction",
keywords="outcome assessment, health care",
abstract="Background: Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective: Our objective was to determine the feasibility and preliminary treatment effects of a smartphone-based weight loss intervention versus food journals to monitor dietary patterns in minority stroke patients. Methods: Swipe out Stroke was a pilot prospective randomized controlled trial with open blinded end point. Minority stroke patients and their caregivers were screened for participation using cluster enrollment. We used adaptive randomization for assignment to a behavior intervention with (1) smartphone-based self-monitoring or (2) food journal self-monitoring. The smartphone group used Lose it! to record meals and communicate with us. Reminder messages (first 30 days), weekly summaries plus reminder messages on missed days (days 31-90), and weekly summaries only (days 91-180) were sent via push notifications. The food journal group used paper diaries. Both groups received 4 in-person visits (baseline and 30, 90, and 180 days), culturally competent counseling, and educational materials. The primary outcome was reduced total body weight. Results: We enrolled 36 stroke patients (n=23, 64\% African American; n=13, 36\% Hispanic), 17 in the smartphone group, and 19 in the food journal group. Mean age was 54 (SD 9) years; mean body mass index was 35.7 (SD 5.7) kg/m2; education, employment status, and family history of stroke or obesity did not differ between the groups. Baseline rates of depression (Patient Health Questionnaire-9 [PHQ-9] score median 5.5, IQR 3.0-9.5), cognitive impairment (Montreal Cognitive Assessment score median 23.5, IQR 21-26), and inability to ambulate (5/36, 14\% with modified Rankin Scale score 3) were similar. In total, 25 (69\%) stroke survivors completed Swipe out Stroke (13/17 in the smartphone group, 12/19 in the food journal group); 1 participant in the smartphone group died. Median weight change at 180 days was 5.7 lb (IQR --2.4 to 8.0) in the smartphone group versus 6.4 lb (IQR --2.2 to 12.5; P=.77) in the food journal group. Depression was significantly lower at 30 days in the smartphone group than in the food journal group (PHQ-9 score 2 vs 8; P=.03). Clinically relevant depression rates remained in the zero to minimal range for the smartphone group compared with mild to moderate range in the food journal group at day 90 (PHQ-9 score 3.5 vs 4.5; P=.39) and day 180 (PHQ-9 score 3 vs 6; P=.12). Conclusions: In a population of obese minority stroke survivors, the use of a smartphone did not lead to a significant difference in weight change compared with keeping a food journal. The presence of baseline depression (19/36, 53\%) was a confounding variable, which improved with app engagement. Future studies that include treatment of poststroke depression may positively influence intervention efficacy. Trial Registration: ClinicalTrials.gov NCT02531074; https://www.clinicaltrials.gov/ct2/show/NCT02531074 ",
doi="10.2196/17816",
url="http://mhealth.jmir.org/2020/4/e17816/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319963"
}


@Article{info:doi/10.2196/14726,
author="Hendrie, A. Gilly
and Hussain, Sazzad M.
and Brindal, Emily
and James-Martin, Genevieve
and Williams, Gemma
and Crook, Anna",
title="Impact of a Mobile Phone App to Increase Vegetable Consumption and Variety in Adults: Large-Scale Community Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="17",
volume="8",
number="4",
pages="e14726",
keywords="mHealth",
keywords="vegetables",
keywords="healthy diet",
keywords="intervention study",
abstract="Background: Large-scale initiatives to improve diet quality through increased vegetable consumption have had small to moderate success. Digital technologies have features that are appealing for health-related behavior change interventions. Objective: This study aimed to describe the implementation and evaluation of a mobile phone app called VegEze, which aims to increase vegetable intake among Australian adults. Methods: To capture the impact of this app in a real-world setting, the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was utilized. An uncontrolled, quantitative cohort study was conducted, with evaluations after 21 and 90 days. The app was available in the Apple App Store and was accompanied by television, radio, and social media promotion. Evaluation surveys were embedded into the app using ResearchKit. The primary outcomes were vegetable intake (servings per day) and vegetable variety (types per day). Psychological variables (attitudes, intentions, self-efficacy, and action planning) and app usage were also assessed. Descriptive statistics and multiple linear regression were used to describe the impact of the app on vegetable intake and to determine the characteristics associated with the increased intake. Results: Data were available from 5062 participants who completed the baseline survey; 1224 participants completed the 21-day survey, and 273 completed the 90-day survey. The participants resided across Australia and were mostly women (4265/5062, 84.3\%) with a mean age of 48.2 years (SD 14.1). The mean increase in intake was 0.48 servings, from 3.06 servings at baseline to 3.54 servings at the end of the 21-day challenge (t1223=8.71; P<.001). The variety of vegetables consumed also increased by 0.35 types per day (t1123=9.59; P<.001). No changes in intake and variety were found from day 21 to the 90-day follow-up. Participants with the highest app usage increased their vegetable intake by 0.63 (SD 2.02) servings per day compared with 0.32 (SD 1.69) servings per day for those with the lowest app usage. On the basis of multiple linear regression, gender; age; BMI; psychological variables of self-efficacy, attitudes, intentions, and action planning specific to vegetable intake; baseline vegetable intake; and active days of app usage accounted for 23.3\% of the variance associated with the change in intake (F9,1208=42.09; P<.001). Baseline vegetable intake was the strongest predictor of change in intake (beta=?.495; P<.001), with lower baseline intake associated with a greater change in intake. Self-efficacy (beta=.116; P<.001), action planning (beta=.066; P=.02), BMI (beta=.070; P=.01), and app usage (beta=.081; P=.002) were all significant predictors of the change in intake. Conclusions: The VegEze app was able to increase intake by half a serving in a large sample of Australian adults. Testing the app in a real-world setting and embedding the consent process allowed for greater reach and an efficient, robust evaluation. Further work to improve engagement is warranted. ",
doi="10.2196/14726",
url="http://mhealth.jmir.org/2020/4/e14726/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301739"
}


@Article{info:doi/10.2196/15534,
author="Brown, Marie Jacqueline
and Savaglio, Robert
and Watson, Graham
and Kaplansky, Allison
and LeSage, Ann
and Hughes, Janette
and Kapralos, Bill
and Arcand, JoAnne",
title="Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="17",
volume="4",
number="4",
pages="e15534",
keywords="mHealth",
keywords="children",
keywords="child nutrition sciences",
keywords="mobile apps",
keywords="health education",
abstract="Background: Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. Objective: This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. Methods: An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. Results: The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71\%), that the app is easy to use (12/17, 71\%) and fun (14/17, 88\%), and that the app goals were clearly presented (15/17, 94\%). Conclusions: Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition. ",
doi="10.2196/15534",
url="http://formative.jmir.org/2020/4/e15534/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301743"
}


@Article{info:doi/10.2196/14196,
author="Lis{\'o}n, Francisco Juan
and Palomar, Gonzalo
and Mensorio, S. Marinna
and Ba{\~n}os, M. Rosa
and Cebolla-Mart{\'i}, Ausi{\`a}s
and Botella, Cristina
and Benavent-Caballer, Vicent
and Rodilla, Enrique",
title="Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="14",
volume="22",
number="4",
pages="e14196",
keywords="web",
keywords="internet",
keywords="overweight",
keywords="obesity",
keywords="hypertension",
abstract="Background: Internet-based interventions are a promising strategy for promoting healthy lifestyle behaviors. These have a tremendous potential for delivering electronic health interventions in scalable and cost-effective ways. There is strong evidence that the use of these programs can lead to weight loss and can lower patients' average blood pressure (BP) levels. So far, few studies have investigated the effects of internet-based programs on patients who are obese with hypertension (HTN). Objective: The aim of this study is to investigate the short- and long-term efficacy, in terms of body composition and BP parameters, of a self-administered internet-based intervention involving different modules and learning techniques aimed at promoting lifestyle changes (both physical activity and healthy eating) in patients who are obese with HTN. Methods: A randomized wait-list controlled trial design was used. We recruited 105 adults with HTN who were overweight or obese and randomly assigned them to either a 3-month internet-based intervention group (n=55) or the wait-list control group (n=50). We assessed BMI (primary outcome), body fat mass (BFM), systolic (S)BP and diastolic (D)BP, blood glucose and insulin levels, physical activity levels, and functional capacity for aerobic exercise at Time 0 (preintervention) and Time 1 (postintervention). All the patients in the wait-list control group subsequently received the intervention, and a secondary within-group analysis, which also included these participants, was conducted at Time 2 (12-month follow-up). Results: A 2-way mixed analysis of covariance showed a significant decrease in BMI, BFM, and blood glucose at 3 months in the internet-based intervention group; the effect size for the BMI and BFM parameters was moderate to large, and there was also a borderline significant trend for DBP and insulin. These results were either maintained or improved upon at Time 2 and showed significant changes for BMI (mean difference ?0.4, 95\% CI ?0.1 to ?0.6; P=.005), BFM (mean difference ?2.4, 95\% CI ?1.1 to ?3.6; P<.001), DBP (mean difference ?1.8, 95\% CI ?0.2 to ?3.3; P=.03), and blood glucose (mean difference ?2, 95\% CI 0 to ?4; P=.04). Conclusions: Implementation of our self-administered internet-based intervention, which involved different learning techniques aimed to promote lifestyle changes, resulted in positive short- and long-term health benefits in patients who are obese with HTN. Trial Registration: ClinicalTrials.gov NCT03396302; https://clinicaltrials.gov/ct2/show/NCT03396302 ",
doi="10.2196/14196",
url="http://www.jmir.org/2020/4/e14196/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32286232"
}


@Article{info:doi/10.2196/14802,
author="Lim, Lin Su
and Johal, Jolyn
and Ong, Wen Kai
and Han, Yixian Chad
and Chan, Huak Yiong
and Lee, Mei Yin
and Loo, Mun Wai",
title="Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="13",
volume="8",
number="4",
pages="e14802",
keywords="diet",
keywords="NAFLD",
keywords="mHealth",
keywords="mobile app, weight loss",
keywords="liver enzymes",
keywords="lifestyle intervention",
abstract="Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) reaches up to 30\% in the Asian adult population, with a higher prevalence in obese patients. Weight reduction is typically recommended for patients at high risk or diagnosed with NAFLD, but is a challenge to achieve. Objective: We aimed to evaluate the effect of a lifestyle intervention with a mobile app on weight loss in NAFLD patients. Methods: This prospective randomized controlled trial included 108 adults with NAFLD confirmed by steatosis on ultrasound and a body mass index ?23 kg/m2 who were recruited from a fatty liver outpatient clinic. The patients were randomly allocated to either a control group (n=53) receiving standard care, consisting of dietary and lifestyle advice by a trained nurse, or an intervention group (n=55) utilizing the Nutritionist Buddy (nBuddy) mobile app in addition to receiving dietary and lifestyle advice by a dietitian. Body weight, alanine aminotransferase (ALT), aspartate aminotransferase (AST), waist circumference, and blood pressure were measured at baseline, and then at 3 and 6 months. Intention-to-treat and per-protocol analyses were used for statistical comparisons. Results: The intervention group had a 5-fold higher likelihood (relative risk 5.2, P=.003, 95\% CI 1.8-15.4) of achieving ?5\% weight loss compared to the control group at 6 months. The intervention group also showed greater reductions in weight (mean 3.2, SD 4.1 kg vs mean 0.5, SD 2.9 kg; P<.001), waist circumference (mean 2.9, SD 5.0 cm vs mean --0.7, SD 4.4 cm; P<.001), systolic blood pressure (mean 12.4, SD 14.8 mmHg vs mean 2.4, SD 12.4 mmHg; P=.003), diastolic blood pressure (mean 6.8, SD 8.9 mmHg vs mean --0.9, SD 10.0 mmHg; P=.001), ALT (mean 33.5, SD 40.4 IU/L vs mean 11.5, SD 35.2 IU/L; P=.004), and AST (mean 17.4, SD 27.5 U/L vs mean 7.4, SD 17.6 IU/L, P=.03) at 6 months. Conclusions: Lifestyle intervention enabled by a mobile app can be effective in improving anthropometric indices and liver enzymes in patients with NAFLD. This treatment modality has the potential to be extended to a larger population scale. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001001381;https://tinyurl.com/w9xnfmp ",
doi="10.2196/14802",
url="http://mhealth.jmir.org/2020/4/e14802/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32281943"
}


@Article{info:doi/10.2196/16431,
author="Espinosa-Curiel, Edrein Ismael
and Pozas-Bogarin, Efr{\'e}n Edgar
and Lozano-Salas, Luis Jorge
and Mart{\'i}nez-Miranda, Juan
and Delgado-P{\'e}rez, Emeth Edwin
and Estrada-Zamarron, Stefania Lizeth",
title="Nutritional Education and Promotion of Healthy Eating Behaviors Among Mexican Children Through Video Games: Design and Pilot Test of FoodRateMaster",
journal="JMIR Serious Games",
year="2020",
month="Apr",
day="13",
volume="8",
number="2",
pages="e16431",
keywords="childhood obesity",
keywords="serious game",
keywords="game design",
keywords="nutritional education",
keywords="dietary intake",
keywords="healthy eating behaviors",
abstract="Background: Childhood obesity has risen dramatically in recent decades, reaching epidemic levels. Children need guidance on and support for maintaining a healthy diet and physical activity to ensure that they grow appropriately and develop healthy eating habits. Serious video games have shown positive effects on promoting the nutritional knowledge, and eating attitudes and behaviors of children; however, research about the usefulness of such games with younger children (8-10 years old) is sparse. Objective: The objective of this study was to design and test the serious video game FoodRateMaster targeting children between 8 and 10 years old. The game includes nutritional information and behavior change techniques to help children improve their knowledge of healthy and unhealthy foods, increase their intake of healthy food, and reduce their intake of ultraprocessed food. In addition, FoodRateMaster was designed as an active game to promote physical activity. Methods: An interdisciplinary team developed FoodRateMaster following an iterative methodology based on a user-centered design. A total of 60 participants (mean age 9 years, SD 0.8; 53\% male) completed 12 individual gaming sessions in 6 weeks. A food knowledge questionnaire and a food frequency questionnaire were completed before and after game play. In addition, 39 of the participants' parents answered a parent perception questionnaire after the game play. Results: Participants showed increased food knowledge from pregame (mean 56.9, SD 10.7) to postgame play (mean 67.8, SD 10.7; P<.001). In addition, there was a greater self-reported frequency in the consumption of cauliflower and broccoli (P<.001) and corn quesadillas (P<.001). They also indicated a lower self-reported intake of 10 unhealthy foods, including french fries (P=.003), candy and chocolate (P<.001), sweet soft cakes (P=.009), and soft drinks (P=.03). Moreover, most of the parents who answered the parent perception questionnaire agreed that their children showed greater interest in explaining why they should avoid some unhealthy foods (67\%, 26/39), in distinguishing between healthy and unhealthy foods (64\%, 25/39), and in the intake of fruits (64\%, 25/39) and vegetables (59\%, 23/39). Finally, 14 parents stated that they introduced some changes in their children's diet based on the comments and suggestions they received from their children. Conclusions: In an initial evaluation, children between 8 and 10 years old indicated an increased level in nutritional knowledge and their self-reported frequency intake of two healthy foods, and a decreased level in their self-reported intake of 10 unhealthy foods after playing FoodRateMaster. Moreover, the participants' parents agreed that FoodRateMaster positively influenced their children's attitudes toward several healthy eating behaviors. These results support that health games such as FoodRateMaster are viable tools to help young children increase their food knowledge and improve dietary behaviors. A follow-up randomized controlled trial will be conducted to assess the medium- and long-term effects of FoodRateMaster. ",
doi="10.2196/16431",
url="http://games.jmir.org/2020/2/e16431/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32281539"
}


@Article{info:doi/10.2196/17613,
author="Watanabe-Ito, Masako
and Kishi, Emiko
and Shimizu, Yoko",
title="Promoting Healthy Eating Habits for College Students Through Creating Dietary Diaries via a Smartphone App and Social Media Interaction: Online Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="31",
volume="8",
number="3",
pages="e17613",
keywords="health promotion",
keywords="college students",
keywords="eating habits",
keywords="social media",
keywords="smartphone app",
abstract="Background: Youth in developed countries face the contradictory health problems of obesity and an excessive desire for weight loss. Developing a better health attitude for college students is essential as this period of life establishes future lifestyle and habits. Online interaction on social media can help to improve eating habits by creating dietary diaries through a smartphone app; however, the effects of such interactions for college students have not been examined to date. Objective: The aim of this study was to evaluate the potential effectiveness of social media interactions with the use of dietary diaries on a smartphone app to motivate college students in raising self-awareness of their eating habits. Methods: Forty-two college students in the greater Tokyo area of Japan participated in the study by creating dietary diaries online through a smartphone app and then followed/interacted with each other using social media for 7 consecutive days in September to November 2017. Online surveys were administered at baseline, immediately after creating the dietary diaries, and at 1-month follow up. Participants rated their degree of interest and self-evaluation of eating habits using 7-point scales, and answered multiple choice questions related to their thoughts in choosing meals/drinks among 10 topics. Free descriptions about their overall experience throughout the project were also collected in the follow-up survey. Results: Data from 38 participants who completed all processes were analyzed. Over time, the mean score for degree of interest in eating habits increased from 4.6 to 6.2 (P<.001), while the self-evaluation score decreased from 4.5 to 3.6 (P<.001); these significant differences remained after 1 month (5.3, P=.002; 4.1, P=0.04, respectively). A weak negative correlation (P=.009) was observed between scores for degree of interest and self-evaluation. Participants with lower scores for degree of interest at baseline tended to increase their interest level by more than 2 points above the average (P<.001). Participants gradually thought more about their eating habits from various perspectives when choosing a meal/drink, particularly with respect to maintaining well-balanced diets and introducing diverse ingredients. Participants evaluated their experiences as interesting/fun and reported familiarity with using the smartphone app and social media as the preferred method to keep track of their eating. All participants welcomed communication with fellow participants on social media and motivated each other, in addition to monitoring their eating habits through online dietary diaries. Some participants experienced difficulty, especially when they were busy or faced a lack of internet access. Conclusions: Through interactions on social media, college students experienced encouragement and developed an interest and critical thinking with respect to their eating habits. This approach, which embraces peer education and peer support with social media, holds promise for the future of youth health promotion. Further examination will be needed to explore how to sustain this level of heightened awareness. ",
doi="10.2196/17613",
url="http://mhealth.jmir.org/2020/3/e17613/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32229468"
}


@Article{info:doi/10.2196/15700,
author="Hwang, Youjin
and Kim, Jun Hyung
and Choi, Jin Hyung
and Lee, Joonhwan",
title="Exploring Abnormal Behavior Patterns of Online Users With Emotional Eating Behavior: Topic Modeling Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="31",
volume="22",
number="3",
pages="e15700",
keywords="emotional eating",
keywords="eating disorder",
keywords="machine learning",
keywords="data-driven research",
keywords="behavior analysis",
keywords="topic modeling",
keywords="Latent Dirichlet Allocation",
abstract="Background: Emotional eating (EE) is one of the most significant symptoms of various eating disorders. It has been difficult to collect a large amount of behavioral data on EE; therefore, only partial studies of this symptom have been conducted. To provide adequate support for online social media users with symptoms of EE, we must understand their behavior patterns to design a sophisticated personalized support system (PSS). Objective: This study aimed to analyze the behavior patterns of emotional eaters as the first step to designing a personalized intervention system. Methods: The machine learning (ML) framework and Latent Dirichlet Allocation (LDA) topic modeling tool were used to collect and analyze behavioral data on EE. Data from a subcommunity of Reddit, /r/loseit, were analyzed. This dataset included all posts and feedback from July 2014 to May 2018, comprising 185,950 posts and 3,528,107 comments. In addition, deleted and improperly collected data were eliminated. Stochastic gradient descent--based ML classifier with an accuracy of 90.64\% was developed to collect refined behavioral data of online users with EE behaviors. The expert group that labeled the dataset to train the ML classifiers included a medical doctor specializing in EE diagnosis and a nutritionist with profound knowledge of EE behavior. The experts labeled 5126 posts as EE (coded as 1) or others (coded as 0). Finally, the topic modeling process was conducted with LDA. Results: The following 4 macroperspective topics of online EE behaviors were identified through linguistic evidence regarding each topic: addressing feelings, sharing physical changes, sharing and asking for dietary information, and sharing dietary strategies. The 5 main topics of feedback were dietary information, compliments, consolation, automatic bot feedback, and health information. The feedback topic distribution significantly differed depending on the type of EE behavior (overall P<.001). Conclusions: This study introduces a data-driven approach for analyzing behavior patterns of social website users with EE behaviors. We discovered the possibility of the LDA topic model as an exploratory user study method for abnormal behaviors in medical research. We also investigated the possibilities of ML- and topic modeling--based classifiers to automatically categorize text-based behavioral data, which could be applied to personalized medicine in future research. ",
doi="10.2196/15700",
url="http://www.jmir.org/2020/3/e15700/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32229461"
}


@Article{info:doi/10.2196/15294,
author="Herzig, David
and Nakas, T. Christos
and Stalder, Janine
and Kosinski, Christophe
and Laesser, C{\'e}line
and Dehais, Joachim
and Jaeggi, Raphael
and Leichtle, Benedikt Alexander
and Dahlweid, Fried-Michael
and Stettler, Christoph
and Bally, Lia",
title="Volumetric Food Quantification Using Computer Vision on a Depth-Sensing Smartphone: Preclinical Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="25",
volume="8",
number="3",
pages="e15294",
keywords="depth camera",
keywords="computer vision",
keywords="dietary assessment",
keywords="smartphone",
abstract="Background: Quantification of dietary intake is key to the prevention and management of numerous metabolic disorders. Conventional approaches are challenging, laborious, and lack accuracy. The recent advent of depth-sensing smartphones in conjunction with computer vision could facilitate reliable quantification of food intake. Objective: The objective of this study was to evaluate the accuracy of a novel smartphone app combining depth-sensing hardware with computer vision to quantify meal macronutrient content using volumetry. Methods: The app ran on a smartphone with a built-in depth sensor applying structured light (iPhone X). The app estimated weight, macronutrient (carbohydrate, protein, fat), and energy content of 48 randomly chosen meals (breakfasts, cooked meals, snacks) encompassing 128 food items. The reference weight was generated by weighing individual food items using a precision scale. The study endpoints were (1) error of estimated meal weight, (2) error of estimated meal macronutrient content and energy content, (3) segmentation performance, and (4) processing time. Results: In both absolute and relative terms, the mean (SD) absolute errors of the app's estimates were 35.1 g (42.8 g; relative absolute error: 14.0\% [12.2\%]) for weight; 5.5 g (5.1 g; relative absolute error: 14.8\% [10.9\%]) for carbohydrate content; 1.3 g (1.7 g; relative absolute error: 12.3\% [12.8\%]) for fat content; 2.4 g (5.6 g; relative absolute error: 13.0\% [13.8\%]) for protein content; and 41.2 kcal (42.5 kcal; relative absolute error: 12.7\% [10.8\%]) for energy content. Although estimation accuracy was not affected by the viewing angle, the type of meal mattered, with slightly worse performance for cooked meals than for breakfasts and snacks. Segmentation adjustment was required for 7 of the 128 items. Mean (SD) processing time across all meals was 22.9 seconds (8.6 seconds). Conclusions: This study evaluated the accuracy of a novel smartphone app with an integrated depth-sensing camera and found highly accurate volume estimation across a broad range of food items. In addition, the system demonstrated high segmentation performance and low processing time, highlighting its usability. ",
doi="10.2196/15294",
url="http://mhealth.jmir.org/2020/3/e15294/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32209531"
}


@Article{info:doi/10.2196/17046,
author="Milne-Ives, Madison
and Lam, Ching
and De Cock, Caroline
and Van Velthoven, Helena Michelle
and Meinert, Edward",
title="Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="18",
volume="8",
number="3",
pages="e17046",
keywords="telemedicine",
keywords="evidence-based medicine",
keywords="mobile health",
keywords="digital health",
keywords="mobile applications",
keywords="app",
keywords="cell phone",
keywords="smartphone",
keywords="mobile phone",
keywords="health behavior",
keywords="intervention",
keywords="behavior change",
keywords="systematic review",
abstract="Background: With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps---their target patient group, health behavior, and behavioral change strategies---has resulted in a large but incohesive body of literature. Objective: This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods: PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results: A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis---37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive---only one app was rated as less helpful and satisfactory than the control---and the studies that measured engagement and usability found relatively high study completion rates (mean 83\%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70\%). However, there was little evidence of changed behavior or health outcomes. Conclusions: There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias. ",
doi="10.2196/17046",
url="http://mhealth.jmir.org/2020/3/e17046/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32186518"
}


@Article{info:doi/10.2196/14118,
author="Martin, Anne
and Caon, Maurizio
and Adorni, Fulvio
and Andreoni, Giuseppe
and Ascolese, Antonio
and Atkinson, Sarah
and Bul, Kim
and Carrion, Carme
and Castell, Conxa
and Ciociola, Valentina
and Condon, Laura
and Espallargues, Mireia
and Hanley, Janet
and Jesuthasan, Nithiya
and Lafortuna, L. Claudio
and Lang, Alexandra
and Prinelli, Federica
and Puidomenech Puig, Elisa
and Tabozzi, A. Sarah
and McKinstry, Brian",
title="A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="2",
volume="8",
number="3",
pages="e14118",
keywords="health behavior",
keywords="obesity",
keywords="co-design",
keywords="mHealth",
keywords="mobile app",
keywords="mobile phone",
keywords="adolescents",
keywords="youth",
keywords="focus groups",
abstract="Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight--promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants' user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents' preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. ",
doi="10.2196/14118",
url="https://mhealth.jmir.org/2020/3/e14118",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130179"
}


@Article{info:doi/10.2196/13055,
author="Widmer, Jay R.
and Senecal, Conor
and Allison, G. Thomas
and Lopez-Jimenez, Francisco
and Lerman, O. Lilach
and Lerman, Amir",
title="Dose-Response Effect of a Digital Health Intervention During Cardiac Rehabilitation: Subanalysis of Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="26",
volume="22",
number="2",
pages="e13055",
keywords="cardiovascular prevention",
keywords="secondary prevention",
keywords="online",
keywords="digital health interventions",
abstract="Background: Previous data have validated the benefit of digital health interventions (DHIs) on weight loss in patients following acute coronary syndrome entering cardiac rehabilitation (CR). Objective: The primary purpose of this study was to test the hypothesis that increased DHI use, as measured by individual log-ins, is associated with improved weight loss. Secondary analyses evaluated the association between log-ins and activity within the platform and exercise, dietary, and medication adherence. Methods: We obtained DHI data including active days, total log-ins, tasks completed, educational modules reviewed, medication adherence, and nonmonetary incentive points earned in patients undergoing standard CR following acute coronary syndrome. Linear regression followed by multivariable models were used to evaluate associations between DHI log-ins and weight loss or dietary adherence. Results: Participants (n=61) were 79\% male (48/61) with mean age of 61.0 (SD 9.7) years. We found a significant positive association of total log-ins during CR with weight loss (r2=.10, P=.03). Educational modules viewed (r2=.11, P=.009) and tasks completed (r2=.10, P=.01) were positively significantly associated with weight loss, yet total log-ins were not significantly associated with differences in dietary adherence (r2=.05, P=.12) or improvements in minutes of exercise per week (r2=.03, P=.36). Conclusions: These data extend our previous findings and demonstrate increased DHI log-ins portend improved weight loss in patients undergoing CR after acute coronary syndrome. DHI adherence can potentially be monitored and used as a tool to selectively encourage patients to adhere to secondary prevention lifestyle modifications. Trial Registration: ClinicalTrials.gov (NCT01883050); https://clinicaltrials.gov/ct2/show/NCT01883050 ",
doi="10.2196/13055",
url="http://www.jmir.org/2020/2/e13055/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130116"
}


@Article{info:doi/10.2196/16481,
author="Partridge, R. Stephanie
and Raeside, Rebecca
and Singleton, C. Anna
and Hyun, Karice
and Latham, Zoe
and Grunseit, Alicia
and Steinbeck, Katharine
and Chow, Clara
and Redfern, Julie",
title="Text Message Behavioral Intervention for Teens on Eating, Physical Activity and Social Wellbeing (TEXTBITES): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="18",
volume="9",
number="2",
pages="e16481",
keywords="obesity",
keywords="adolescents",
keywords="nutrition",
keywords="physical activity",
keywords="text message",
keywords="randomized controlled trial",
keywords="mHealth",
abstract="Background: Obesity is among the most significant health challenges facing today's adolescents. Weight gain during adolescence is related to cardiovascular disease, type 2 diabetes, and some cancers in later life. Presently, adolescents living in Australia have limited access to age-appropriate obesity prevention services. Objective: This study aims to investigate whether a two-way text message program, with optional telephone health counseling, improves body mass index (BMI) z score and lifestyle outcomes in adolescents who are overweight. Methods: This study will be a single-blind randomized controlled trial (N=150) comparing a two-way text message intervention, with optional telephone health counseling, to usual care in adolescents (13-18 years old, inclusive) who are overweight (recruited from a pediatric weight management clinic and the broader community in Sydney, Australia). The intervention group will receive a six-month text message program, which consists of two-way, semipersonalized, lifestyle-focused text messages (four messages/week) in addition to usual care. The control group will be assigned to receive usual care. The study also includes a follow-up at 12-months. The primary outcome is a change in BMI z score at six months. Secondary outcomes are changes in waist-to-height ratio, diet, physical and sedentary activity levels, sleep quality, quality of life, self-esteem, self-efficacy, social support, and eating disorder and depression symptoms. Also, we will examine acceptability, utility, and engagement with the program through a study-specific process evaluation questionnaire, semi-structured telephone interviews, and an analysis of health counselor communication logs. The analyses will be performed by the intention-to-treat principle to assess differences between intervention and control groups. Results: The study opened for recruitment in December 2019. Data collection is expected to be completed by December 2021, and the results for the primary outcome are expected to be published in early 2022. Conclusions: This study will test the effectiveness of an interactive two-way text message program compared to usual care in improving BMI z score and lifestyle outcomes in adolescents with overweight. This interactive, innovative, and scalable project also aims to inform future practice and community initiatives to promote obesity prevention behaviors for adolescents. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000389101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377158\&amp;isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/16481 ",
doi="10.2196/16481",
url="https://www.researchprotocols.org/2020/2/e16481",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130194"
}


@Article{info:doi/10.2196/13747,
author="Hern{\'a}ndez-Reyes, Alberto
and C{\'a}mara-Martos, Fernando
and Molina Recio, Guillermo
and Molina-Luque, Rafael
and Romero-Salda{\~n}a, Manuel
and Moreno Rojas, Rafael",
title="Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Feb",
day="12",
volume="8",
number="2",
pages="e13747",
keywords="exercise",
keywords="text message",
keywords="mobile phone",
keywords="mHealth",
keywords="health behavior",
keywords="behavior maintenance",
keywords="physical activity",
keywords="push",
abstract="Background: Technology---in particular, access to the Internet from a mobile device---has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs. Objective: A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA). Methods: A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months. Results: Receiving notifications during the intervention increased body fat loss (mean -12.9\% [SD 6.7] in the intervention group vs mean -7.0\% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8\% [SD 4.5] in the intervention group vs mean -3.2\% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05). Conclusions: Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched. Trial Registration: ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583 ",
doi="10.2196/13747",
url="http://mhealth.jmir.org/2020/2/e13747/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32049065"
}


@Article{info:doi/10.2196/13401,
author="Grady, Alice
and Wolfenden, Luke
and Wiggers, John
and Rissel, Chris
and Finch, Meghan
and Flood, Victoria
and Salajan, David
and O'Rourke, Ruby
and Stacey, Fiona
and Wyse, Rebecca
and Lecathelinais, Christophe
and Barnes, Courtney
and Green, Sue
and Herrmann, Vanessa
and Yoong, Lin Sze",
title="Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="4",
volume="22",
number="2",
pages="e13401",
keywords="child care",
keywords="child, preschool",
keywords="online systems",
keywords="menu planning",
keywords="nutrition policy",
keywords="randomized controlled trial",
keywords="internet-based intervention",
abstract="Background: Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. Objective: This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed. Methods: A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. Results: No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. Conclusions: Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx ",
doi="10.2196/13401",
url="https://www.jmir.org/2020/2/e13401",
url="http://www.ncbi.nlm.nih.gov/pubmed/32014843"
}


@Article{info:doi/10.2196/13266,
author="Osadchiy, Timur
and Poliakov, Ivan
and Olivier, Patrick
and Rowland, Maisie
and Foster, Emma",
title="Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="3",
volume="22",
number="2",
pages="e13266",
keywords="computer systems",
keywords="nutrition surveys",
keywords="diet records",
keywords="nutrition assessment",
keywords="epidemiologic methods",
abstract="Background: Under-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment. Objective: This study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall. Methods: The experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall. Results: Retention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65\% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65\% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall. Conclusions: The analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system. ",
doi="10.2196/13266",
url="https://www.jmir.org/2020/2/e13266",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012055"
}


@Article{info:doi/10.2196/13273,
author="Kim, Youngin
and Oh, Bumjo
and Shin, Hyun-Young",
title="Effect of mHealth With Offline Antiobesity Treatment in a Community-Based Weight Management Program: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="21",
volume="8",
number="1",
pages="e13273",
keywords="obesity",
keywords="mobile apps",
keywords="mobile health",
keywords="weight loss",
abstract="Background: Weight loss interventions using mobile phone apps have recently shown promising results. Objective: This study aimed to analyze the short-term weight loss effect of a mobile coaching intervention when it is integrated with a local public health care center and a regional hospital's antiobesity clinic as a multidisciplinary model. Methods: A total of 150 overweight or obese adults signed up to complete an 8-week antiobesity intervention program with human coaching through a mobile platform. Paired t tests and multiple linear regression analysis were used to identify the intervention factors related to weight change. Results: Among the 150 participants enrolled in this study, 112 completed the 8-week weight loss intervention. Weight (baseline: mean 77.5 kg, SD 12.9; after intervention: mean 74.8 kg, SD 12.6; mean difference ?2.73 kg), body mass index, waist circumference, fat mass (baseline: mean 28.3 kg, SD 6.6; after intervention: mean 25.7 kg, SD 6.3; mean difference ?2.65 kg), and fat percentage all showed a statistically significant decrease, and metabolic equivalent of task (MET) showed a statistically significant increase after intervention. In multiple linear regression analysis, age (beta=.07; P=.06), ?MET (beta=?.0009; P=.10), number of articles read (beta=?.01; P=.04), and frequency of weight records (beta=?.05; P=.10; R2=0.4843) were identified as significant factors of weight change. Moreover, age (beta=.06; P=.03), sex (female; beta=1.16; P=.08), ?MET (beta=?.0009; P<.001), and number of articles read (beta=?.02; P<.001; R2=0.3728) were identified as significant variables of fat mass change. Conclusions: The multidisciplinary approach, combining a mobile health (mHealth) care app by health care providers, was effective for short-term weight loss. Additional studies are needed to evaluate the efficacy of mHealth care apps in obesity treatment. ",
doi="10.2196/13273",
url="http://mhealth.jmir.org/2020/1/e13273/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31961335"
}


@Article{info:doi/10.2196/15189,
author="Idris, Iskandar
and Hampton, James
and Moncrieff, Fiona
and Whitman, Michael",
title="Effectiveness of a Digital Lifestyle Change Program in Obese and Type 2 Diabetes Populations: Service Evaluation of Real-World Data",
journal="JMIR Diabetes",
year="2020",
month="Jan",
day="20",
volume="5",
number="1",
pages="e15189",
keywords="weight loss",
keywords="mHealth",
keywords="type 2 diabetes",
keywords="OurPath",
keywords="obesity",
keywords="dietetics",
keywords="cognitive behavioral therapy",
keywords="empowerment",
keywords="well-being",
keywords="mobile app",
keywords="behavior change",
keywords="prevention",
keywords="digital",
abstract="Background: The prevalence of type 2 diabetes mellitus (T2DM) and obesity is increasing, and the way people interact with health care is evolving. People traditionally access advice and support to improve their lifestyle and learn more about the self-management of T2DM in a face-to-face setting. Although these services have a strong evidence base, they have limitations for reaching specific groups of people. Digital programs could provide a new delivery model to help more people access health education and behavior change support, but long-term data supporting these programs are limited. Objective: The purpose of this service evaluation was to analyze the weight change of people who participated in OurPath (also known as Second Nature), a UK-based digital lifestyle change program, for either weight management or diabetes-related weight management and structured education at 6 and 12 months. Methods: Participants either paid to access the program privately (self-funded clients) or were referred by their general practitioner to participate in the program free of charge (funded by the National Health Service). Additional follow-up support was provided to help people to maintain lifestyle changes. To retrospectively assess potential weight loss, the analysis included data from participants who submitted weight readings at baseline and 6 and 12 months after starting the program. Changes in weight after 6 and 12 months were primary outcome measures. Results: For the 896 participants who submitted baseline and 6- and 12-month data, a significant change in mean weight of ?7.12 kg (?7.50\%; SD 6.37; P<.001) was observed at 6 months. Data from the same participants at 12 months showed a change in mean weight when compared with a baseline of ?6.14 kg (?6.48\%; SD 6.97; P<.001). Conclusions: The data presented here had several limitations, and there were too many uncertainties to make any reliable conclusions. However, these results suggest that digital lifestyle change programs could provide a new way to help people to access nutritional advice and support to achieve weight loss. Further research into digital education and coaching platforms is needed to establish their effectiveness. ",
doi="10.2196/15189",
url="http://diabetes.jmir.org/2020/1/e15189/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31958064"
}


@Article{info:doi/10.2196/13191,
author="Wahl, Ronja Deborah
and Villinger, Karoline
and Blumenschein, Michael
and K{\"o}nig, Maria Laura
and Ziesemer, Katrin
and Sproesser, Gudrun
and Schupp, Thomas Harald
and Renner, Britta",
title="Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="7",
volume="8",
number="1",
pages="e13191",
keywords="mHealth",
keywords="eating",
keywords="motivation",
keywords="mobile app",
keywords="EMA",
keywords="in-the-moment",
keywords="disposition",
keywords="trait",
keywords="state",
abstract="Background: Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). Objective: This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. Methods: A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person {\texttimes} motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. Results: Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person {\texttimes} motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. Conclusions: For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes. ",
doi="10.2196/13191",
url="https://mhealth.jmir.org/2020/1/e13191",
url="http://www.ncbi.nlm.nih.gov/pubmed/31909719"
}


@Article{info:doi/10.2196/13854,
author="C{\^o}t{\'e}, M{\'e}lina
and Lapointe, Annie
and Laram{\'e}e, Catherine
and Lemieux, Simone
and Desroches, Sophie
and Belanger-Gravel, Ariane
and Lamarche, Beno{\^i}t",
title="Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study",
journal="JMIR Form Res",
year="2019",
month="Dec",
day="10",
volume="3",
number="4",
pages="e13854",
keywords="focus groups",
keywords="qualitative research",
keywords="social class",
keywords="research subject",
keywords="retention",
abstract="Background: NutriQu{\'e}bec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Qu{\'e}bec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. Objective: This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQu{\'e}bec project and to identify their preferences regarding recruitment methods. Methods: A total of four focus groups were conducted in community centers located in low-income areas of Qu{\'e}bec City, Canada. On the basis of the theory of planned behavior, participants' beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQu{\'e}bec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. Results: Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can \$19,999 or less. The main perceived advantages of participating in the NutriQu{\'e}bec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. Conclusions: These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet. ",
doi="10.2196/13854",
url="http://formative.jmir.org/2019/4/e13854/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31821149"
}


@Article{info:doi/10.2196/14904,
author="Alshurafa, Nabil
and Lin, Wen Annie
and Zhu, Fengqing
and Ghaffari, Roozbeh
and Hester, Josiah
and Delp, Edward
and Rogers, John
and Spring, Bonnie",
title="Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="4",
volume="21",
number="12",
pages="e14904",
keywords="computer vision systems",
keywords="computing methodologies",
keywords="diet",
keywords="energy intake",
keywords="eating",
keywords="eHealth",
keywords="feeding behavior",
keywords="mHealth",
keywords="nutritional status",
keywords="obesity",
keywords="wearable technology",
abstract="Background: Conventional diet assessment approaches such as the 24-hour self-reported recall are burdensome, suffer from recall bias, and are inaccurate in estimating energy intake. Wearable sensor technology, coupled with advanced algorithms, is increasingly showing promise in its ability to capture behaviors that provide useful information for estimating calorie and macronutrient intake. Objective: This paper aimed to summarize current technological approaches to monitoring energy intake on the basis of expert opinion from a workshop panel and to make recommendations to advance technology and algorithms to improve estimation of energy expenditure. Methods: A 1-day invitational workshop sponsored by the National Science Foundation was held at Northwestern University. A total of 30 participants, including population health researchers, engineers, and intervention developers, from 6 universities and the National Institutes of Health participated in a panel discussing the state of evidence with regard to monitoring calorie intake and eating behaviors. Results: Calorie monitoring using technological approaches can be characterized into 3 domains: (1) image-based sensing (eg, wearable and smartphone-based cameras combined with machine learning algorithms); (2) eating action unit (EAU) sensors (eg, to measure feeding gesture and chewing rate); and (3) biochemical measures (eg, serum and plasma metabolite concentrations). We discussed how each domain functions, provided examples of promising solutions, and highlighted potential challenges and opportunities in each domain. Image-based sensor research requires improved ground truth (context and known information about the foods), accurate food image segmentation and recognition algorithms, and reliable methods of estimating portion size. EAU-based domain research is limited by the understanding of when their systems (device and inference algorithm) succeed and fail, need for privacy-protecting methods of capturing ground truth, and uncertainty in food categorization. Although an exciting novel technology, the challenges of biochemical sensing range from a lack of adaptability to environmental effects (eg, temperature change) and mechanical impact, instability of wearable sensor performance over time, and single-use design. Conclusions: Conventional approaches to calorie monitoring rely predominantly on self-reports. These approaches can gain contextual information from image-based and EAU-based domains that can map automatically captured food images to a food database and detect proxies that correlate with food volume and caloric intake. Although the continued development of advanced machine learning techniques will advance the accuracy of such wearables, biochemical sensing provides an electrochemical analysis of sweat using soft bioelectronics on human skin, enabling noninvasive measures of chemical compounds that provide insight into the digestive and endocrine systems. Future computing-based researchers should focus on reducing the burden of wearable sensors, aligning data across multiple devices, automating methods of data annotation, increasing rigor in studying system acceptability, increasing battery lifetime, and rigorously testing validity of the measure. Such research requires moving promising technological solutions from the controlled laboratory setting to the field. ",
doi="10.2196/14904",
url="https://www.jmir.org/2019/12/e14904",
url="http://www.ncbi.nlm.nih.gov/pubmed/31799938"
}


@Article{info:doi/10.2196/13140,
author="Yang, Ching Shu
and Luo, Fang Yi
and Chiang, Chia-Hsun",
title="Electronic Health Literacy and Dietary Behaviors in Taiwanese College Students: Cross-Sectional Study",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="26",
volume="21",
number="11",
pages="e13140",
keywords="college",
keywords="dietary",
keywords="health literacy",
keywords="students",
abstract="Background: Given the recognized importance of preventing poor dietary behaviors during adolescence, we need a better understanding of college students' dietary behaviors. Studies have found that individual factors and electronic health (eHealth) literacy may affect one's dietary behaviors. However, few studies have fully investigated the effect of the three levels of eHealth literacy (functional, interactive, and critical) and the interactive effect of individual factors (eg, gender, monthly expenses, and frequency of cooking) and the three levels of eHealth literacy on the four aspects of dietary behaviors (consumer health, balanced diet, regular eating habits, and unhealthy food intake). Objective: This study aimed to investigate whether individual differences and higher eHealth literacy are associated with more positive dietary behaviors and less unhealthy dietary intake. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students' functional, interactive, and critical eHealth literacy. The Dietary Behaviors Scale is a 14-item instrument developed to measure four aspects of dietary behaviors of college students. A questionnaire was administered to collect background information about participants' gender, monthly expenses, and frequency of cooking. A national sample of college students was surveyed, and 813 responses were obtained. We conducted a multiple regression analysis to examine the association among individual factors, eHealth literacy, and dietary behaviors. Results: This study found that functional eHealth literacy was negatively related to unhealthy food intake (beta=?.11; P=.01), and interactive eHealth literacy was positively related to balanced diet (beta=.25; P<.001) and consumer health (beta=.15; P=.02). Moreover, critical eHealth literacy was positively related to consumer health (beta=.30; P<.001) and regular eating habits (beta=.20; P=.002). Finally, the interactive effect between gender and interactive eHealth literacy was negatively related to balanced diet (beta=?.22; P<.001). The interactive effect between monthly expenses and functional eHealth literacy was positively related to balanced diet (beta=.07; P=.03), although the interactive effect between monthly expenses and critical eHealth literacy was negatively related to balanced diet (beta=?.10; P=.047). Conclusions: This study showed that Taiwanese college students with higher functional eHealth literacy were more likely to engage in fewer unhealthy food consumption practices. Those who had higher interactive and critical eHealth literacy were more likely to engage in positive dietary behaviors than those with functional eHealth literacy. Surprisingly, females with high interactive eHealth literacy were more likely to have a poor balanced diet. In contrast, students with higher monthly expenses and higher functional eHealth literacy were more likely to have a balanced diet. However, students with higher monthly expenses and higher critical eHealth literacy were less likely to maintain a balanced diet. ",
doi="10.2196/13140",
url="http://www.jmir.org/2019/11/e13140/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31769760"
}


@Article{info:doi/10.2196/14380,
author="Appleton, Marie Katherine
and Passmore, David
and Burn, Isobel
and Pidgeon, Hanna
and Nation, Philippa
and Boobyer, Charlotte
and Jiang, Nan",
title="An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="20",
volume="7",
number="11",
pages="e14380",
keywords="fruit",
keywords="vegetables",
keywords="diet therapy",
keywords="knowledge",
keywords="questionnaires",
keywords="portion sizes",
abstract="Background: Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations. Objective: This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations. Methods: Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won't have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app. Results: Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge. Conclusions: A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population. Trial Registration: ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491 ",
doi="10.2196/14380",
url="http://mhealth.jmir.org/2019/11/e14380/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31746766"
}


@Article{info:doi/10.2196/11158,
author="Han, Kyu Min
and Cho, Belong
and Kwon, Hyuktae
and Son, Young Ki
and Lee, Hyejin
and Lee, Kyung Joo
and Park, Jinho",
title="A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="4",
volume="7",
number="11",
pages="e11158",
keywords="weight loss programs",
keywords="smartphone",
keywords="mobile phone",
keywords="workplaces",
keywords="obesity",
keywords="obesity management",
abstract="Background: There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone--delivered interventions. Objective: This study aimed to develop and verify an integrated and personalized mobile technology--based weight control program, named Health-On, optimized for workplaces. Methods: A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ?25 kg/m2) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. Results: Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8\%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (P<.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; P<.05) also improved significantly. Conclusions: In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence. ",
doi="10.2196/11158",
url="https://mhealth.jmir.org/2019/11/e11158",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682576"
}


@Article{info:doi/10.2196/12966,
author="Appleton, Marie Katherine
and Bray, Jeff
and Price, Sarah
and Liebchen, Gernot
and Jiang, Nan
and Mavridis, Ioannis
and Saulais, Laure
and Giboreau, Agn{\`e}s
and Perez-Cueto, A. Federico J.
and Coolen, Rebecca
and Ronge, Manfred
and Hartwell, Heather",
title="A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation",
journal="JMIR Form Res",
year="2019",
month="Nov",
day="4",
volume="3",
number="4",
pages="e12966",
keywords="eating",
keywords="eating behavior",
keywords="food",
keywords="diet",
keywords="mhealth",
keywords="mobile app",
keywords="digitalhealth",
keywords="smartphone",
abstract="Background: Increasing pressure from governments, public health bodies, and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten outside the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: This paper aimed to describe the development and early assessment of a mobile phone app that allows the provision of accurate personalized food-based information while considering individual characteristics (allergies, diet type, and preferences) to enable informed consumer choice when eating out. Methods: An app was designed and developed to address these requirements using an agile approach. The developed app was then evaluated at 8 public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating-out situation, including the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalize the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: This paper details the successful development and early assessment of a novel mobile phone app designed to provide food-based information in an eating-out situation in a personalized manner. ",
doi="10.2196/12966",
url="http://formative.jmir.org/2019/4/e12966/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682575"
}


@Article{info:doi/10.2196/12298,
author="Meule, Adrian
and Richard, Anna
and Dinic, Radomir
and Blechert, Jens",
title="Effects of a Smartphone-Based Approach-Avoidance Intervention on Chocolate Craving and Consumption: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="1",
volume="7",
number="11",
pages="e12298",
keywords="food",
keywords="chocolate",
keywords="craving",
keywords="smartphone",
keywords="mobile phone",
keywords="mhealth",
keywords="digital health",
keywords="eating behavior",
abstract="Background: Repeatedly pushing high-calorie food stimuli away based on joystick movements has been found to reduce approach biases toward these stimuli. Some studies also found that such avoidance training reduced consumption of high-calorie foods. Objective: This study aimed to test effects of a smartphone-based approach-avoidance intervention on chocolate craving and consumption, to make such interventions suitable for daily use. Methods: Within a 10-day period, regular chocolate eaters (n=105, 86\% female) performed five sessions during which they continuously avoided (ie, swiped upward) chocolate stimuli (experimental group, n=35), performed five sessions during which they approached and avoided chocolate stimuli equally often (placebo control group, n=35), or did not perform any training sessions (inactive control group, n=35). Training effects were measured during laboratory sessions before and after the intervention period and further continuously through daily ecological momentary assessment. Results: Self-reported chocolate craving and consumption as well as body fat mass significantly decreased from pre- to postmeasurement across all groups. Ecological momentary assessment reports evidenced no differences in chocolate craving and consumption between intervention days and rest days as a function of the group. Conclusions: A smartphone-based approach-avoidance training did not affect eating-related and anthropometric measures over and above measurement-based changes in this study. Future controlled studies need to examine whether other techniques of modifying food approach tendencies show an add-on benefit over conventional, monitoring-based intervention effects. Trial Registration: AsPredicted 8203; https://aspredicted.org/pt9df.pdf. ",
doi="10.2196/12298",
url="https://mhealth.jmir.org/2019/11/e12298",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682584"
}


@Article{info:doi/10.2196/14074,
author="Smit, Suzanne Eline
and Zeidler, Chamoetal
and Resnicow, Ken
and de Vries, Hein",
title="Identifying the Most Autonomy-Supportive Message Frame in Digital Health Communication: A 2x2 Between-Subjects Experiment",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="30",
volume="21",
number="10",
pages="e14074",
keywords="health communication",
keywords="health behavior",
keywords="personal autonomy",
keywords="internet",
keywords="health promotion",
keywords="healthy diet",
keywords="self-determination theory",
abstract="Background: The effectiveness of digital health communication may be increased by enhancing autonomy supportiveness. Objective: This study aimed to identify the most autonomy-supportive message frame within an intervention for increasing vegetable intake by testing the effect of the following 2 strategies: (1) using autonomy-supportive language and (2) providing choice. Methods: A Web-based 2 (autonomy-supportive vs controlling language){\texttimes}2 (choice vs no choice) experiment was conducted among 526 participants, recruited via a research panel. The main outcome measures were perceived autonomy support (measured using the Virtual Care Climate Questionnaire, answered with scores 1 to 5), perceived relevance (measured with one question, answered with scores 1 to 5), and overall evaluation of the intervention (measured with 1 open-ended question, answered with scores 1 to 10). Results: Choice had a significant positive effect on the overall evaluation of the intervention (b=.12; P=.003), whereas for participants with a high need for autonomy, there was a significant positive effect on perceived relevance (b=.13; P=.02). The positive effect of choice on perceived autonomy support approached significance (b=.07; P=.07). No significant effects on any of the three outcomes were observed for language. Conclusions: Results suggest that provision of choice rather than the use of autonomy-supportive language can be an easy-to-implement strategy to increase the effectiveness of digital forms of health communication, especially for people with a high need for autonomy. ",
doi="10.2196/14074",
url="http://www.jmir.org/2019/10/e14074/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31670693"
}


@Article{info:doi/10.2196/13013,
author="Li, Ling-Jun
and Aris, M. Izzuddin
and Han, Meng Wee
and Tan, Hian Kok",
title="A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App",
journal="JMIR Form Res",
year="2019",
month="Oct",
day="24",
volume="3",
number="4",
pages="e13013",
keywords="overweight, obesity, pregnant women",
keywords="gestational weight gain",
keywords="food diary",
keywords="randomized controlled trial",
keywords="smartphone app",
keywords="food coaching",
keywords="dietary recommendation",
keywords="feasibility",
abstract="Background: Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes. Objective: In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women. Methods: We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups. Results: Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90\%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67\%) than in the control group (5/14, 36\%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=--0.08 kg; 95\% CI --1.80 to 1.63) and cholesterol intake (mean difference=--31.73 mg; 95\% CI --102.91 to 39.45) than those in the control group. Conclusions: Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women. ",
doi="10.2196/13013",
url="http://formative.jmir.org/2019/4/e13013/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31651407"
}


@Article{info:doi/10.2196/13935,
author="Oostingh, C. Elsje
and Ophuis, H. Robbin
and Koster, PH Maria
and Polinder, Suzanne
and Lingsma, F. Hester
and Laven, SE Joop
and Steegers-Theunissen, PM R{\'e}gine",
title="Mobile Health Coaching on Nutrition and Lifestyle Behaviors for Subfertile Couples Using the Smarter Pregnancy Program: Model-Based Cost-Effectiveness Analysis",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="23",
volume="7",
number="10",
pages="e13935",
keywords="preconception",
keywords="subfertility",
keywords="IVF treatment",
keywords="pregnancy",
keywords="cost-effectiveness",
abstract="Background: The health care costs for reproductive care have substantially increased with the use of in vitro fertilization (IVF) treatment. The mobile health (mHealth) coaching program Smarter Pregnancy is an effective intervention to improve nutrition and lifestyle behaviors and pregnancy rates in (sub)fertile couples, including those who undergo IVF treatment. Therefore, we hypothesize that this mHealth program can also reduce health care costs associated with IVF treatment. Objective: This study aimed to evaluate the cost-effectiveness of the mHealth coaching program Smarter Pregnancy and compare it to usual care in women of subfertile couples who start their first IVF cycle. Methods: This model-based cost-effectiveness analysis was performed on data from couples undergoing IVF treatment at the Erasmus MC, University Medical Center Rotterdam. A decision tree model was used to assess the incremental cost-effectiveness ratio (ICER) of ongoing pregnancies and costs of use of the mHealth program as compared to usual care. A probabilistic sensitivity analysis was performed to consider the uncertainty surrounding the point estimates of the input parameters. Results: Based on our model including 793 subfertile women undergoing IVF treatment, use of the mHealth program resulted in 86 additional pregnancies and saved {\texteuro}270,000 compared to usual care after two IVF cycles, with an ICER of --{\texteuro}3050 (95\% CI --3960 to --540) per additional pregnancy. The largest cost saving was caused by the avoided IVF treatment costs. Sensitivity analyses showed that the mHealth program needs to increase the ongoing pregnancy rate by at least 51\% after two IVF cycles for cost saving. Conclusions: The mHealth coaching program Smarter Pregnancy is potentially cost saving for subfertile couples preceding their first IVF treatment. Implementation of this mHealth program in routine preconception care for subfertile couples should be seriously considered, given the relatively low costs and promising cost-effectiveness estimates. ",
doi="10.2196/13935",
url="http://mhealth.jmir.org/2019/10/e13935/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647476"
}


@Article{info:doi/10.2196/15738,
author="Hamatani, Sayo
and Numata, Noriko
and Matsumoto, Kazuki
and Sutoh, Chihiro
and Ibuki, Hanae
and Oshiro, Keiko
and Tanaka, Mari
and Setsu, Rikukage
and Kawasaki, Yohei
and Hirano, Yoshiyuki
and Shimizu, Eiji",
title="Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial",
journal="JMIR Form Res",
year="2019",
month="Oct",
day="23",
volume="3",
number="4",
pages="e15738",
keywords="bulimia nervosa",
keywords="binge-eating disorder",
keywords="cognitive behavioral therapy",
keywords="internet-based cognitive behavioral therapy",
keywords="videoconference",
abstract="Background: A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan. Objective: The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods: Seven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory--Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95\% confidence intervals using the paired t test. Results: Although the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71\% reduction) and showed a medium effect size (Cohen d=--0.76), there was no significant reduction in the combined episodes (EDE 16D --41; 95\% CI --2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment. Conclusions: ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration: UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000033419 ",
doi="10.2196/15738",
url="http://formative.jmir.org/2019/4/e15738/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647472"
}


@Article{info:doi/10.2196/13340,
author="Moores, Jane Carly
and Maeder, Anthony
and Miller, Jacqueline
and Prichard, Ivanka
and Lewis, Kate Lucy
and Bell, Kate Lucinda
and Macoustra, Aimee
and Miller, D. Michelle",
title="A Digital Intervention for Australian Adolescents Above a Healthy Weight (Health Online for Teens): Protocol for an Implementation and User Experience Study",
journal="JMIR Res Protoc",
year="2019",
month="Oct",
day="10",
volume="8",
number="10",
pages="e13340",
keywords="adolescent",
keywords="overweight",
keywords="diet",
keywords="exercise behavior",
abstract="Background: More than one-fourth of Australian adolescents are overweight or obese, with obesity in adolescents strongly persisting into adulthood. Recent evidence suggests that the mid-teen years present a final window of opportunity to prevent irreversible damage to the cardiovascular system. As lifestyle behaviors may change with increased autonomy during adolescence, this life stage is an ideal time to intervene and promote healthy eating and physical activity behaviors, well-being, and self-esteem. As teenagers are prolific users and innate adopters of new technologies, app-based programs may be suitable for the promotion of healthy lifestyle behaviors and goal setting training. Objective: This study aims to explore the reach, engagement, user experience, and satisfaction of the new app-based and Web-based Health Online for Teens (HOT) program in a sample of Australian adolescents above a healthy weight (ie, overweight or obese) and their parents. Methods: HOT is a 14-week program for adolescents and their parents. The program is delivered online through the Moodle app--based and website-based learning environment and aims to promote adolescents' lifestyle behavior change in line with Australian Dietary Guidelines and Australia's Physical Activity and Sedentary Behaviour Guidelines for Young People (aged 13-17 years). HOT aims to build parental and peer support during the program to support adolescents with healthy lifestyle behavior change. Results: Data collection for this study is ongoing. To date, 35 adolescents and their parents have participated in one of 3 groups. Conclusions: HOT is a new online-only program for Australian adolescents and their parents that aims to reduce cardiovascular disease risk factors. This protocol paper describes the HOT program in detail, along with the methods to measure reach, outcomes, engagement, user experiences, and program satisfaction. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000465257; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374771 International Registered Report Identifier (IRRID): DERR1-10.2196/13340 ",
doi="10.2196/13340",
url="https://www.researchprotocols.org/2019/10/e13340",
url="http://www.ncbi.nlm.nih.gov/pubmed/31603435"
}


@Article{info:doi/10.2196/12572,
author="Lindroos, Karin Anna
and Petrelius Sipinen, Jessica
and Axelsson, Cecilia
and Nyberg, Gisela
and Landberg, Rikard
and Leanderson, Per
and Arnemo, Marianne
and Warensj{\"o} Lemming, Eva",
title="Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="4",
volume="21",
number="10",
pages="e12572",
keywords="dietary assessment",
keywords="24-hour hour dietary recalls",
keywords="internet",
keywords="validity",
keywords="biomarkers",
keywords="carotenoids",
keywords="alkylresorcinols",
keywords="adolescents",
abstract="Background: A Web-based dietary assessment tool---RiksmatenFlex---was developed for the national dietary survey of adolescents in Sweden. Objective: This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. Methods: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. Results: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8\% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02). Conclusions: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases. ",
doi="10.2196/12572",
url="https://www.jmir.org/2019/10/e12572",
url="http://www.ncbi.nlm.nih.gov/pubmed/31588902"
}


@Article{info:doi/10.2196/11235,
author="Colby, Sarah
and Moret, Lauren
and Olfert, D. Melissa
and Kattelmann, Kendra
and Franzen-Castle, Lisa
and Riggsbee, Kristin
and Payne, Magen
and Ellington, Ainsley
and Springer, Cary
and Allison, Chelsea
and Wiggins, Sa'Nealdra
and Butler, Rochelle
and Mathews, Douglas
and White, A. Adrienne",
title="Incorporating Technology Into the iCook 4-H Program, a Cooking Intervention for Adults and Children: Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2019",
month="Aug",
day="29",
volume="2",
number="2",
pages="e11235",
keywords="technology",
keywords="videos",
keywords="intervention",
keywords="cooking",
keywords="child health",
abstract="Background: Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed. Objective: The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program. Methods: Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum. Results: Only 78.6\% (81/103) of children and 68.3\% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement. Conclusions: Incorporating technological supports, such as cameras and websites, into children's programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions. Trial Registration: ISRCTN Registry ISRCTN54135351;?https://www.isrctn.com/ISRCTN54135351 ",
doi="10.2196/11235",
url="http://pediatrics.jmir.org/2019/2/e11235/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518323"
}


@Article{info:doi/10.2196/14430,
author="LeRouge, Cynthia
and Durneva, Polina
and Sangameswaran, Savitha
and Gloster, Anne-Marie",
title="Design Guidelines for a Technology-Enabled Nutrition Education Program to Support Overweight and Obese Adolescents: Qualitative User-Centered Design Study",
journal="J Med Internet Res",
year="2019",
month="Jul",
day="29",
volume="21",
number="7",
pages="e14430",
keywords="healthy eating",
keywords="user-computer interface",
keywords="consumer health informatics",
keywords="adolescent",
keywords="obesity",
keywords="overweight",
keywords="nutrition",
keywords="cooking",
keywords="user-centered design",
abstract="Background: Childhood overweight and obesity are major health challenges in the United States. One of the recommendations to combat obesity is to maintain a healthy diet, which is often best supported by eating home-cooked meals to control cooking methods, ingredients, and portions. Diet control through home cooking is challenged because of the decline in culinary skills in the population and a paucity of effective culinary nutrition education (CNE) programs. Providing technology-enabled CNE (CNE-tech) to overweight and obese adolescents can equip them with life skills that can assist them in the future. Such skills can facilitate saving money, eating healthier, and creating social environments. In addition, CNE builds cooking confidence and food literacy that in turn can build adolescent self-efficacy, particularly toward managing their health behaviors. Objective: This study aimed to inform functionalities, design requirements, and the context of use for CNE-tech that could enhance overweight and obese adolescents' healthy food literacy, cooking confidence, and general self-efficacy with regard to self-management to ultimately promote healthy lifestyle management. Methods: The design science study was completed in 2 distinct phases engaging overweight and obese adolescents, parents of overweight and obese adolescents, and the health care providers that treat adolescents with these conditions. Phase 2, our primary source of data, involved user-centered design methods including the following: (1) early stage prototype usability analysis, (2) semistructured interviews with 70 overweight or obese adolescents engaged in a healthy behavior program, and (3) semistructured interviews with 10 health care providers. Data were analyzed using constant comparison analysis to identify functionalities, design requirements, and inform the context of use of CNE-tech. Results: Data revealed specific desired functionalities for the CNE-tech related to building cooking skills, populating a healthy recipe database, suggesting healthy alternatives, supporting the construction of a healthy plate, and the ability to share healthy recipes and cooking accomplishments. Moreover, the adolescents provided design requirements pertaining to the presentation (eg, vivid colors, semirealistic images, and cooking sounds), use of multimedia, and gaming. Data further revealed contextual factors, such as shared experiences with family members and enhanced continued use. Conclusions: We demonstrate the potentiality of creating CNE-tech that could effectively lead to better self-care and induce sustainable behavioral change as it facilitates skill building, self-efficacy, and a pathway that enables overweight and obese adolescents to influence cooking habits in their family home and future dwellings. Our CNE-tech--proposed solution aligns with the goals of overweight and obese adolescents and also reflects existing theories about behavioral change. ",
doi="10.2196/14430",
url="http://www.jmir.org/2019/7/e14430/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31359871"
}


@Article{info:doi/10.2196/14097,
author="M{\"u}ller, Ivan
and Smith, Danielle
and Adams, Larissa
and Aerts, Ann
and Damons, P. Bruce
and Degen, Jan
and Gall, Stefanie
and Gani, Zaahira
and Gerber, Markus
and Gresse, Annelie
and van Greunen, Darelle
and Joubert, Nandi
and Marais, Tracey
and Nqweniso, Siphesihle
and Probst-Hensch, Nicole
and du Randt, Rosa
and Seelig, Harald
and Steinmann, Peter
and Utzinger, J{\"u}rg
and Wadhwani, Christina
and Walter, Cheryl
and P{\"u}hse, Uwe",
title="Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Jul",
day="11",
volume="8",
number="7",
pages="e14097",
keywords="anthropometry",
keywords="cardiovascular",
keywords="cognitive function",
keywords="diabetic complications",
keywords="children's health",
keywords="marginalization",
keywords="physical activity",
keywords="physical fitness",
keywords="schools",
keywords="South Africa",
abstract="Background: The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers. Objectives: The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers. Methods: A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching. Results: This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings. Conclusions: The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa's Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers' productivity with trickle-down effects on the children they teach and train. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542 International Registered Report Identifier (IRRID): DERR1-10.2196/14097 ",
doi="10.2196/14097",
url="http://www.researchprotocols.org/2019/7/e14097/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31298224"
}


@Article{info:doi/10.2196/13549,
author="Fedele, David
and Lucero, Robert
and Janicke, David
and Abu-Hasan, Mutasim
and McQuaid, Elizabeth
and Moon, Jon
and Fidler, Andrea
and Wallace-Farquharson, Tanya
and Lindberg, David",
title="Protocol for the Development of a Behavioral Family Lifestyle Intervention Supported by Mobile Health to Improve Weight Self-Management in Children With Asthma and Obesity",
journal="JMIR Res Protoc",
year="2019",
month="Jun",
day="24",
volume="8",
number="6",
pages="e13549",
keywords="asthma",
keywords="obesity",
keywords="child",
keywords="family",
keywords="program development",
abstract="Background: Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ?9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions. Objective: We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app. Methods: Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses. Results: This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019. Conclusions: Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users. International Registered Report Identifier (IRRID): DERR1-10.2196/13549 ",
doi="10.2196/13549",
url="http://www.researchprotocols.org/2019/6/e13549/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31237240"
}


@Article{info:doi/10.2196/14265,
author="Asbj{\o}rnsen, Aune Rikke
and Smedsr{\o}d, Lien Mirjam
and Solberg Nes, Lise
and Wentzel, Jobke
and Varsi, Cecilie
and Hjelmes{\ae}th, J{\o}ran
and van Gemert-Pijnen, EWC Julia",
title="Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="21",
volume="21",
number="6",
pages="e14265",
keywords="eHealth",
keywords="weight loss maintenance",
keywords="weight loss",
keywords="behavior change",
keywords="persuasive technology",
keywords="review",
keywords="motivation",
keywords="adherence",
abstract="Background: Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed. Objective: This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance. Methods: A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O'Malley's scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change. Results: The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24\%) focused on weight loss maintenance, and 34 (76\%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62\%). Frequently used wearables were activity trackers (14/45, 31\%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18\%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors. Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance. ",
doi="10.2196/14265",
url="http://www.jmir.org/2019/6/e14265/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31228174"
}


@Article{info:doi/10.2196/11917,
author="Ben Neriah, Daniela
and Geliebter, Allan",
title="Weight Loss Following Use of a Smartphone Food Photo Feature: Retrospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="29",
volume="7",
number="6",
pages="e11917",
keywords="food intake",
keywords="digital photography",
keywords="app tracking",
keywords="dietary assessment",
keywords="free-living",
abstract="Background: Tracking of dietary intake is key to enhancing weight loss. Mobile apps may be useful for tracking food intake and can provide feedback about calories and nutritional value. Recent technological developments have enabled image recognition to identify foods and track food intake. Objective: We aimed to determine the effectiveness of using photography as a feature of a smartphone weight loss app to track food intake in adults who were overweight or obese. Methods: We analyzed data from individuals (age, 18-65 years; body mass index?25 kg/m2; ?4 days of logged food intake; and ?2 weigh-ins) who used a mobile-based weight loss app. In a retrospective study, we compared those who used the photo feature (n=9871) and those who did not use the feature (n=113,916). Linear regression analyses were used to assess use of the photo feature in relation to percent weight loss. Results: Weight loss was greater in the group using the photo feature ($\Delta$=0.14\%; 95\% CI 0.06-0.22; P<.001). The photo feature group used the weight loss app for a longer duration (+3.5 days; 95\% CI 2.61-4.37; P<.001) and logged their food intake on more days (+6.1 days; 95\% CI 5.40-6.77; P<.001) than the nonusers. Mediation analysis showed that the weight loss effect was absent when controlling for either duration or number of logged days in the program. Conclusions: This study was the first to examine the effect of a food photo feature to track food intake on weight loss in a free-living setting. Use of photo recognition was associated with greater weight loss, which was mediated by the duration of app use and number of logged days in the program. ",
doi="10.2196/11917",
url="https://mhealth.jmir.org/2019/6/e11917/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199300"
}


@Article{info:doi/10.2196/10923,
author="Alnasser, Aroub
and Kyle, Janet
and Aloumi, Najla
and Al-Khalifa, Abdulrahman
and Marais, Debbi",
title="The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="28",
volume="7",
number="5",
pages="e10923",
keywords="obesity",
keywords="weight loss",
keywords="mobile applications",
keywords="smartphone",
keywords="obesity management",
keywords="mHealth",
abstract="Background: By 2022, it is estimated that the rate of female obesity (78\%) in Saudi Arabia will almost double that of males (41\%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention. Objective: This study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations. Methods: A pre-post single?arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time. Results: A total of 40 participants completed the 4-month intervention with an attrition rate of 83\%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65\%) and unengaged users (35\%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake. Conclusions: The findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations. ",
doi="10.2196/10923",
url="http://mhealth.jmir.org/2019/5/e10923/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31140444"
}


@Article{info:doi/10.2196/12326,
author="Kliemann, Nathalie
and Croker, Helen
and Johnson, Fiona
and Beeken, J. Rebecca",
title="Development of the Top Tips Habit-Based Weight Loss App and Preliminary Indications of Its Usage, Effectiveness, and Acceptability: Mixed-Methods Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="10",
volume="7",
number="5",
pages="e12326",
keywords="weight loss",
keywords="habits",
keywords="mobile apps",
keywords="mHealth",
abstract="Background: The Ten Top Tips (10TT) is an intervention based on the habit formation theory that promotes a set of weight management behaviors alongside advice about repetition in a consistent context. Overall, 3 studies have demonstrated that the 10TT can support individuals to lose weight when delivered in a leaflet format. Delivery of 10TT via new technology such as a mobile app could potentially improve its effectiveness and make it more convenient, appealing, and wide reaching. Objective: This study aimed to provide preliminary indications of the usage, effectiveness, and acceptability of an Android app of the 10TT intervention (Top Tips only app) and a second version including self-regulatory strategies for dealing with tempting foods (Top Tips plus app). Methods: The 3-month pilot randomized adults with overweight or obesity to (1) Top Tips only app, (2) Top Tips plus app, or (3) waiting list condition. Automated data from app users were collected. Validated questionnaires assessed self-regulatory skills, weight loss (kg), and behaviors at baseline and 3 months. Users' feedback on their experience using the app was assessed using open questions. Results: A total of 81 participants took part in the pilot; 28 participants were randomized to the Top Tips only app, 27 to the Top Tips plus app, and 26 to the waiting list condition. On average, participants viewed a mean of 43.4 (SD 66.9) screens during a mean of 24.5 (SD 44.07) log-ins and used the app for 124.2 (SD 240.2) min over the 3-month period. Participants randomized to the Top Tips only app reported the greatest improvement in self-regulatory skills (mean 0.59, SD 1.0), weight loss (mean 4.5 kg, SD 5.2), and adherence to the target behaviors (mean 0.59, SD 0.49) compared with the Top Tips plus (meanself-regulation 0.15, SD 0.42; meanweight ?1.9, SD 3.9; and meanbehaviors 0.29, SD 0.29) and waiting list condition (meanself-regulation ?0.02, SD 0.29; meanweight ?0.01, SD 0.51; and meanbehaviors 0.08, SD 0.38). Participants who reported the largest improvements, on average, viewed pages 2 to 3 times more, had 2 to 3 times more log-ins, logged their weight 2 to 3 times more, and achieved the tips more than those who reported smaller changes in these outcomes. According to users' feedback, engagement with the app could be increased by making the app more interactive and allowing more tailoring. Conclusions: This study suggests that the Top Tips app could potentially be a useful intervention for promoting eating self-regulatory skills, weight loss, and weight management behaviors among adults with overweight or obesity. Future research should develop the app further based on user feedback and test it in larger sample sizes. Trial Registration: ISRCTN Registry ISRCTN10470937; http://www.isrctn.com/ISRCTN10470937 (Archived by Webcite at http://www.webcitation.org/76j6rQibI) ",
doi="10.2196/12326",
url="https://mhealth.jmir.org/2019/5/e12326/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094352"
}


@Article{info:doi/10.2196/13324,
author="Nour, Monica
and Chen, Juliana
and Allman-Farinelli, Margaret",
title="Young Adults' Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study",
journal="JMIR Form Res",
year="2019",
month="May",
day="10",
volume="3",
number="2",
pages="e13324",
keywords="vegetables",
keywords="young adults",
keywords="mHealth",
keywords="social media",
keywords="experimental game",
abstract="Background: Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement. Objective: This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake. Methods: A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 {\texttimes} 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts. Results:  Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49\% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64\% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60\% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed. Conclusions: As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery. ",
doi="10.2196/13324",
url="http://formative.jmir.org/2019/2/e13324/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094322"
}


@Article{info:doi/10.2196/10942,
author="Wang, Tao
and Mentzakis, Emmanouil
and Brede, Markus
and Ianni, Antonella",
title="Estimating Determinants of Attrition in Eating Disorder Communities on Twitter: An Instrumental Variables Approach",
journal="J Med Internet Res",
year="2019",
month="May",
day="03",
volume="21",
number="5",
pages="e10942",
keywords="medical informatics",
keywords="eating disorders",
keywords="social media",
keywords="attrition",
keywords="emotions",
keywords="social network",
keywords="causality",
keywords="instrumental variables",
abstract="Background: The use of social media as a key health information source has increased steadily among people affected by eating disorders (EDs). Research has examined characteristics of individuals engaging in online communities, whereas little is known about discontinuation of engagement and the phenomenon of participants dropping out of these communities. Objective: This study aimed to investigate the characteristics of dropout behaviors among eating disordered individuals on Twitter and to estimate the causal effects of personal emotions and social networks on dropout behaviors. Methods: Using a snowball sampling method, we collected a set of individuals who self-identified with EDs in their Twitter profile descriptions, as well as their tweets and social networks, leading to 241,243,043 tweets from 208,063 users. Individuals' emotions are measured from their language use in tweets using an automatic sentiment analysis tool, and network centralities are measured from users' following networks. Dropout statuses of users are observed in a follow-up period 1.5 years later (from February 11, 2016 to August 17, 2017). Linear and survival regression instrumental variables models are used to estimate the effects of emotions and network centrality on dropout behaviors. The average levels of attributes among an individual's followees (ie, people who are followed by the individual) are used as instruments for the individual's attributes. Results: Eating disordered users have relatively short periods of activity on Twitter with one half of our sample dropping out at 6 months after account creation. Active users show more negative emotions and higher network centralities than dropped-out users. Active users tend to connect to other active users, whereas dropped-out users tend to cluster together. Estimation results suggest that users' emotions and network centralities have causal effects on their dropout behaviors on Twitter. More specifically, users with positive emotions are more likely to drop out and have shorter lasting periods of activity online than users with negative emotions, whereas central users in a social network have longer lasting participation than peripheral users. Findings on users' tweeting interests further show that users who attempt to recover from EDs are more likely to drop out than those who promote EDs as a lifestyle choice. Conclusions: Presence in online communities is strongly determined by the individual's emotions and social networks, suggesting that studies analyzing and trying to draw condition and population characteristics through online health communities are likely to be biased. Future research needs to examine in more detail the links between individual characteristics and participation patterns if better understanding of the entire population is to be achieved. At the same time, such attrition dynamics need to be acknowledged and controlled when designing online interventions so as to accurately capture their intended populations. ",
doi="10.2196/10942",
url="https://www.jmir.org/2019/5/e10942/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066718"
}


@Article{info:doi/10.2196/12289,
author="Haas, Karin
and Hayoz, Stefanie
and Maurer-Wiesner, Susanne",
title="Effectiveness and Feasibility of a Remote Lifestyle Intervention by Dietitians for Overweight and Obese Adults: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="11",
volume="7",
number="4",
pages="e12289",
keywords="remote consultation",
keywords="obesity",
keywords="weight loss",
keywords="mobile app",
keywords="behavior therapy",
keywords="healthy lifestyle",
keywords="healthy diet",
abstract="Background: To tackle the problem of obesity and related diseases in Switzerland, cost-efficient, effective, and innovative primary health care interventions for weight management are required. In this context, Oviva has developed a scalable technology for registered dietitians to counsel overweight and obese patients via a mobile phone app. Objective: The aim of this study was to evaluate the effectiveness and feasibility of weight loss counseling by dietitians using a mobile phone app for patients with overweight and obesity. Methods: In this pre- and posttest pilot study, overweight and obese adults participated in a 1-year behavioral intervention to lose weight through remote counseling by dietitians in the German-speaking part of Switzerland. The study started in April 2016 and finished in May 2018. Participants received individual counseling through the app and the exchange with the dietitian focused on regular feedback on photo-based food log, motivation, and education. The contents were tailored to the individual lifestyle goal set. The predefined intensity of remote counseling decreased during the year. Group chat could be used. The outcomes examined were changes in weight (primary outcome), hemoglobin A1c, fasting glucose, fasting insulin, triglyceride, high-density lipoprotein cholesterol, blood pressure (BP), body mass index (BMI), waist circumference, body fat, and responses to a self-administered questionnaire with questions regarding participants' physical activity, dietary assessment, and health-related quality of life. Changes were tested at baseline, after 3 months, and after 12 months, as well as between the third and the 12th month. Results: In total, 36 women and 7 men, with a mean age of 40.6 years, participated and 36 participants completed the study. Median weight change after the first 12 weeks was ?3.8 kg (range: ?15 to 2.4 and P<.001), between week 12 and week 52 it was ?1.1 kg (range: ?9.7 to 7 and P=.08), and the median change during the entire period of intervention was ?4.9 kg (range: ?21.9 to 7.5 and P<.001). Furthermore, changes in BMI, waist circumference, body fat, and BP between baseline and 12 weeks and between baseline and 52 weeks were also significant. Significant changes in certain eating habits were also demonstrated (higher frequency of vegetable, fruit, and breakfast consumption and lower frequency of alcohol, sweet, and fat consumption). Conclusions: In addition to the professional skills of a dietitian, a profession-specific app such as Oviva can provide effective support that meets the needs of dietitians and clients on the long path of behavioral change and sustainable weight reduction. Trial Registration: ClinicalTrials.gov NCT02694614; https://clinicaltrials.gov/ct2/show/NCT02694614 (Archived by WebCite at http://www.webcitation.org/76gYkGOIc) ",
doi="10.2196/12289",
url="https://mhealth.jmir.org/2019/4/e12289/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30973338"
}


@Article{info:doi/10.2196/11664,
author="Gootjes, V. Dionne
and van Dijk, R. Matthijs
and Koster, PH Maria
and Willemsen, P. Sten
and Steegers, AP Eric
and Steegers-Theunissen, PM R{\'e}gine",
title="Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="11",
volume="7",
number="4",
pages="e11664",
keywords="pregnancy",
keywords="telemedicine",
keywords="lifestyle",
keywords="nutritional status",
keywords="preconception care",
abstract="Background: In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. Objective: This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. Methods: We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 {\textmu}g per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. Results: Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95\% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95\% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95\% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26\% and 64\%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95\% CI 0.82-0.97). Conclusions: The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation. ",
doi="10.2196/11664",
url="https://mhealth.jmir.org/2019/4/e11664/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30973345"
}


@Article{info:doi/10.2196/formative.9910,
author="Harrington, A. Richard
and Scarborough, Peter
and Hodgkins, Charo
and Raats, M. Monique
and Cowburn, Gill
and Dean, Moira
and Doherty, Aiden
and Foster, Charlie
and Juszczak, Edmund
and Ni Mhurchu, Cliona
and Winstone, Naomi
and Shepherd, Richard
and Timotijevic, Lada
and Rayner, Mike",
title="A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="08",
volume="3",
number="2",
pages="e9910",
keywords="diet",
keywords="randomized controlled trial",
abstract="Background: Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. Objective: The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). Results: We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). Conclusions: Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. Trial Registration: ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK) International Registered Report Identifier (IRRID): RR2-10.1186/s40814-015-0015-1 ",
doi="10.2196/formative.9910",
url="http://formative.jmir.org/2019/2/e9910/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30958277"
}


@Article{info:doi/10.2196/12047,
author="Lu, Wenhua
and Guttentag, Alexandra
and Elbel, Brian
and Kiszko, Kamila
and Abrams, Courtney
and Kirchner, R. Thomas",
title="Crowdsourcing for Food Purchase Receipt Annotation via Amazon Mechanical Turk: A Feasibility Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="05",
volume="21",
number="4",
pages="e12047",
keywords="Amazon Mechanical Turk",
keywords="food purchase receipt",
keywords="crowdsourcing",
keywords="feasibility",
keywords="reliability",
keywords="validity",
abstract="Background: The decisions that individuals make about the food and beverage products they purchase and consume directly influence their energy intake and dietary quality and may lead to excess weight gain and obesity. However, gathering and interpreting data on food and beverage purchase patterns can be difficult. Leveraging novel sources of data on food and beverage purchase behavior can provide us with a more objective understanding of food consumption behaviors. Objective: Food and beverage purchase receipts often include time-stamped location information, which, when associated with product purchase details, can provide a useful behavioral measurement tool. The purpose of this study was to assess the feasibility, reliability, and validity of processing data from fast-food restaurant receipts using crowdsourcing via Amazon Mechanical Turk (MTurk). Methods: Between 2013 and 2014, receipts (N=12,165) from consumer purchases were collected at 60 different locations of five fast-food restaurant chains in New Jersey and New York City, USA (ie, Burger King, KFC, McDonald's, Subway, and Wendy's). Data containing the restaurant name, location, receipt ID, food items purchased, price, and other information were manually entered into an MS Access database and checked for accuracy by a second reviewer; this was considered the gold standard. To assess the feasibility of coding receipt data via MTurk, a prototype set of receipts (N=196) was selected. For each receipt, 5 turkers were asked to (1) identify the receipt identifier and the name of the restaurant and (2) indicate whether a beverage was listed in the receipt; if yes, they were to categorize the beverage as cold (eg, soda or energy drink) or hot (eg, coffee or tea). Interturker agreement for specific questions (eg, restaurant name and beverage inclusion) and agreement between turker consensus responses and the gold standard values in the manually entered dataset were calculated. Results: Among the 196 receipts completed by turkers, the interturker agreement was 100\% (196/196) for restaurant names (eg, Burger King, McDonald's, and Subway), 98.5\% (193/196) for beverage inclusion (ie, hot, cold, or none), 92.3\% (181/196) for types of hot beverage (eg, hot coffee or hot tea), and 87.2\% (171/196) for types of cold beverage (eg, Coke or bottled water). When compared with the gold standard data, the agreement level was 100\% (196/196) for restaurant name, 99.5\% (195/196) for beverage inclusion, and 99.5\% (195/196) for beverage types. Conclusions: Our findings indicated high interrater agreement for questions across difficulty levels (eg, single- vs binary- vs multiple-choice items). Compared with traditional methods for coding receipt data, MTurk can produce excellent-quality data in a lower-cost, more time-efficient manner. ",
doi="10.2196/12047",
url="http://www.jmir.org/2019/4/e12047/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30950801"
}


@Article{info:doi/10.2196/10189,
author="Almenara, A. Carlos
and Machackova, Hana
and Smahel, David",
title="Sociodemographic, Attitudinal, and Behavioral Correlates of Using Nutrition, Weight Loss, and Fitness Websites: An Online Survey",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="04",
volume="21",
number="4",
pages="e10189",
keywords="body image",
keywords="compulsive behavior",
keywords="diet",
keywords="feeding and eating disorders",
keywords="individuality",
keywords="internet",
keywords="user-computer interface",
keywords="weight loss",
keywords="social support",
abstract="Background: Nutrition, diet, and fitness are among the most searched health topics by internet users. Besides that, health-related internet users are diverse in their motivations and individual characteristics. However, little is known about the individual characteristics associated with the usage of nutrition, weight loss, and fitness websites. Objective: The aim of this study was to examine the individual factors associated with the usage of nutrition, weight loss, and fitness websites. Methods: An invitation to an online survey was published on 65 websites and discussion forums. In total, we employed data from 623 participants (aged 13 to 39 years, mean 24.11 [SD 5.26]). The measures included frequency of usage of nutrition, weight loss and fitness websites, excessive exercise, eating disorder symptomatology, internalization of the beauty ideal, weight status, and perceived online social support. Participants' data were used as predictors in a base linear regression model. Results: The final model had an acceptable fit ($\chi$210 =14.1; P=.17; root mean square error of approximation=0.03; comparative fit index=0.99; Tucker-Lewis index=0.99). Positive associations were found between usage of (1) nutrition websites and being female, higher levels of excessive exercise, and perceived online social support; (2) weight loss websites and excessive exercise, internalization, being female, eating disorder symptomatology, and being overweight or obese; and (3) fitness websites and levels of excessive exercise, internalization, and frequency of internet use. Conclusions: The results highlighted the importance of individual differences in the usage of health-related websites. ",
doi="10.2196/10189",
url="https://www.jmir.org/2019/4/e10189/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30946018"
}


@Article{info:doi/10.2196/12501,
author="Chung, Alicia
and Wallace, Barbara
and Stanton-Koko, Monica
and Seixas, Azizi
and Jean-Louis, Girardin",
title="Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Mar",
day="22",
volume="2",
number="1",
pages="e12501",
keywords="childhood obesity",
keywords="eHealth",
keywords="social justice",
abstract="Background: African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. Objective: This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. Methods: Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. Results: A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. Conclusions: Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions. ",
doi="10.2196/12501",
url="http://pediatrics.jmir.org/2019/1/e12501/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518320"
}


@Article{info:doi/10.2196/11874,
author="Denison-Day, James
and Muir, Sarah
and Newell, Ciar{\'a}n
and Appleton, M. Katherine",
title="A Web-Based Intervention (MotivATE) to Increase Attendance at an Eating Disorder Service Assessment Appointment: Zelen Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="27",
volume="21",
number="2",
pages="e11874",
keywords="feeding disorders",
keywords="eating disorders",
keywords="anorexia nervosa",
keywords="bulimia nervosa",
keywords="binge-eating disorder",
keywords="motivation",
keywords="early medical intervention",
keywords="Internet",
abstract="Background: Early assessment and treatment of eating disorder patients is important for patient outcomes. However, up to a third of people referred for treatment do not access services and 16.4\% do not attend their first scheduled assessment appointment. MotivATE is a fully automated, novel, Web-based program intended to increase motivation to change eating disorder behaviors, designed for delivery at the point of invitation to an eating disorder service, with the aim of increasing service attendance. Objective: This paper assesses the impact of MotivATE on attendance at assessment when compared with treatment-as-usual. Methods: A Zelen randomized controlled design was used. All individuals referred to a specialist eating disorder service, Kimmeridge Court in Dorset, UK, over the course of a year (October 24, 2016-October 23, 2017) were randomized to treatment-as-usual only or treatment-as-usual plus an additional letter offering access to MotivATE. Attendance at the initial scheduled assessment appointment was documented. Logistic regression analysis assessed the impact of MotivATE on attendance at assessment. Additional analyses based on levels of engagement with MotivATE were also undertaken. Results: A total of 313 participants took part: 156 (49.8\%) were randomized to treatment-as-usual and 157 (50.2\%) were randomized to receive the additional offer to access MotivATE. Intention-to-treat analysis between conditions showed no impact of MotivATE on attendance at assessment (odds ratio [OR] 1.35, 95\% CI 0.69-2.66, P=.38). Examination of the usage data indicated that only 53 of 157 participants (33.8\%) in the MotivATE condition registered with the Web-based intervention. An analysis comparing those that registered with the intervention with those that did not found greater attendance at assessment in those that had registered (OR 9.46, 95\% CI 1.22-73.38, P=.03). Conclusions: Our primary analyses suggest no impact of MotivATE on attendance at the first scheduled assessment appointment, but secondary analyses revealed limited engagement with the program and improved attendance in those who did engage. It is unclear, however, if engagement with the program increased motivation and, in turn, attendance or if more motivated individuals were more likely to access the intervention. Further research is required to facilitate engagement with Web-based interventions and to understand the full value of MotivATE for users. Trial Registration: ClinicalTrials.gov NCT02777944; https://clinicaltrials.gov/ct2/show/NCT02777944 (Archived by WebCite at http://www.webcitation.org/75VDEFZZ4) ",
doi="10.2196/11874",
url="http://www.jmir.org/2019/2/e11874/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30810533"
}


@Article{info:doi/10.2196/11964,
author="Hammersley, L. Megan
and Okely, D. Anthony
and Batterham, J. Marijka
and Jones, A. Rachel",
title="An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="08",
volume="21",
number="2",
pages="e11964",
keywords="internet",
keywords="eHealth",
keywords="food intake",
keywords="physical activity",
keywords="screen time",
keywords="sleep",
keywords="self efficacy",
keywords="body mass index",
abstract="Background: Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children. Objective: This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy. Methods: The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection. Results: A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91\% (78/86) were in the healthy weight range. Overall, 69\% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate ?1.36, 95\% CI ?2.27 to ?0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (?0.30, 95\% CI 0.06 to ?0.00; P=.048) and nutrition self-efficacy (0.43, 95\% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes. Conclusions: The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. Trial Registration: Australian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ). ",
doi="10.2196/11964",
url="http://www.jmir.org/2019/2/e11964/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30735139"
}


@Article{info:doi/10.5210/ojphi.v4i3.4321,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2012",
volume="4",
number="3",
pages="e4321",
doi="10.5210/ojphi.v4i3.4321",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/23569653"
}