We conducted a systematic review to determine if the use of nutrition apps resulted in improved outcomes, including knowledge and behavior, among healthy adults. Using app(s), cellular phone, iPads, mobile phone, mobile telephone, smart phone, mobile and mHealth as search terms with diet, food and nutrition as qualifiers we searched PubMed, CINAHL (January 2008-October 2013) and Web of Science (January 2008-January 2014). Inclusion criteria were peer-reviewed randomized controlled trials, non-controlled trials, and cohort studies published in English that used apps to increase nutrition knowledge or improve behavior related to nutrition. Studies that were descriptive, did not include apps, focused on app development, app satisfaction app feasibility, text messaging, or digital photography were excluded. We evaluated article quality using the Academy of Nutrition and Dietetics Evidence Analysis Manual. Data was extracted for knowledge, behavior and weight change. Our initial search identified 12,010 titles from PubMed, 260 from CINAHL and 4762 from Web of Science; of these, only four articles met all search criteria. Positive quality ratings were given to three articles; only one reported knowledge outcomes (non-significant). All four articles evaluated weight loss and suggested an advantage to using nutrition apps. Behavioral changes in reviewed studies included increased adherence to diet monitoring (p < 0.001) and decreased effort to continue diet without app (p = 0.024). Few studies, however, have explored the use of nutrition apps as supportive educational interventions. Most apps focus on weight loss with inconsistent outcomes. We conclude that using apps for education needs additional research which includes behavior theory within the app and improved study design.

BackgroundThe extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling.ObjectiveThe goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps’ educational quality and technical functionality.MethodsItems for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app.ResultsDevelopment and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support.ConclusionsOur preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps’ qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed.

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estimate adjusted odds ratios (AOR) for consuming SSBs $3 times/day based on knowledge of SSB-related health conditions using <1 time/day as the reference category. Results: Overall, 36% of Hispanic adults consumed SSBs $3 times/day. Although most identified that weight gain (75%) and diabetes (76%) are related to drinking SSBs, only half identified that cavities (57%) and hypertension (41%) are related to drinking SSBs. Even fewer adults identified high cholesterol (32%) and heart disease (32%) as related to drinking SSBs. In crude analyses, lower SSB intake was associated with knowledge of the relationships between SSBs and weight gain, cavities, and heart disease (p<0.05, c2 test); however, after adjusting for age, sex, education, marital status, income, weight status, region, country of origin, and acculturation, these associations were no longer significant. Conclusions and Implications: Most Hispanic adults knew that SSB intake was related to weight gain and diabetes, but knowledge was limited for other health conditions. Knowledge of SSB-related health conditions alone may not be related to reported SSB intake, and therefore insufficient for Hispanic adult behavior change.

Objectives To determine through systematic review whether parental involvement in interventions to improve eating habits of children was more often associated with positive dietary behavior changes as compared to those with no or low involvement. Methods Web of Science, PsychInfo, PubMed, and EBSCO were searched for studies between 2004–2016 that aimed to change children's (2 to 12 years old) diet quality (diet quality; and 1 or more eating behavior component: fruit (F), vegetables (V), whole grains, lower saturated fat, lower sugar-sweetened beverages (SSB), and intake of calcium-rich foods). Preferred Reporting Items for Systematic Reviews and Meta-Analysis were followed for this review. Parental involvement was classified as low, medium, or high involvement. Diet assessment tools were scored for their reliability and validity. The influence of theoretical framework on outcomes was not included in the current review. Results Of 443 papers, data was extracted from 156 randomized controlled trials, and 26 met inclusion criteria. Most studies focused on the intake of F and/or V or SSB. Most with low parental involvement reported no significant dietary change (12 of 15 diet measures in 8 studies). Half with medium/medium-high involvement found significant diet change (4 of 8 measures, 3 studies). More positive diet change resulted with high parental involvement (13 of 18 measures, 11 studies). All studies with no parental involvement reported significant positive changes except 1 (4 studies, 5 measures); 3 studies incorporated exposure to F&V, 1 aimed to lower SSB. Conclusions Increasing level of parental involvement supports dietary behavior change in children. Without parental involvement, repeated F&V exposure also increases intake. Nutrition professionals should engage parents at multiple time points in child dietary interventions to achieve positive dietary changes. Direct F&V exposure is an option if parental involvement is not feasible. Funding Sources This work was supported by the USDA National Institute of Food and Agriculture through Multistate Hatch Capacity Funds supporting the W-3005 research group and respective universities.

Critical thinking is an important skill in all academic disciplines, but it can be difficult to develop assessments that adequately evaluate how critical thinking has changed over the period of a semester. In the context of health promotion, it is essential to prepare learners to appraise health information and misinformation, identify health disparities and work to address them, engage in health promotion practices that are culturally sensitive, theoretically driven, evidence-based, and acknowledge the role of social determinants of health and health behaviors. Health Behavior Theory is a fundamental subject taught in health promotion programs. While a large part of this subject matter involves the learning of health behavior theory, it presents an opportunity where critical thinking can be fostered through embodied pedagogy. Since students have had years of exposure to health information, as well as personal and observed experiences with health behavior, students come with many preconceived notions about the subject matter. In this article, we describe the use of a scaffolded experience of embodied behavior change and self-reflection, culminating in the creation of an autoethnography as a pedagogical experience which can support critical thinking in learners. We describe the development, implementation, and evaluation of the autoethnography assignment. As an embodied pedagogy, the autoethnography experience provides students with valuable insight into the difficulties of behavior change on an individual level while connecting individual experiences with social discourses that influence diverse meanings related to health behavior.

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