Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (−5.7% (95% CI: −10.4 to −1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: −1.0 to 5.8)), total fats (−5.9% (95% CI: −8.9 to −3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (−17.5 g/day (95% CI: −34.0 to −1.1)), and processed meat (−6.6 g/day (95% CI: −13.1 to −0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.

In recent years, the use of applications to improve dietary habits has increased. Although numerous nutrition apps are available on the market, only few have been developed by health and nutrition professionals based on scientific evidence and subsequently tested to prove their usability. The main objective of this study was to design, develop, and evaluate the usability of a tailored nutrition application to be used to promote healthy eating habits. In order to decide app design and content, three focus groups took place with fifteen professionals from primary healthcare, nutrition, and food science and computer science, as well as expert users. For the general and feedback message design, a reference model based on the scientific literature was developed. To address the multi-perspective approach of users' and external healthcare professionals' feedback, a one-day pilot testing with potential users and healthcare professionals was conducted with four focus groups. To evaluate the relevance and potential usability of the app a 1-month pilot test was conducted in a real-life environment. A total of 42 volunteers participated in the one-day pilot testing, and 39 potential users participated in the 1-month pilot test. The SAlBi educa app developed includes an online dietary record, a self-monitoring tool to evaluate dietary patterns, general and feedback messages, and examples of traditional Mediterranean recipes. The usability study showed that volunteers think that SAlBi educa is pleasant (59%) and easy to learn to use (94%). Over 84% of the volunteers declared that the nutritional messages were clear and useful. Volunteers stated that general and tailored recommendations, as well as self-monitoring, were SAlBi educa's most motivating and useful features. SAlBi educa is an innovative, user-friendly nutritional education tool with the potential to engage and help individuals to follow dietary habits based on the Mediterranean model.

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BACKGROUND Mobile applications are one of the fastest growing technology fields in recent years. The rise of smartphones and the special concern about food in the population, as well as the increase in overweight and obesity and their association with non-communicable diseases, makes it necessary to combine both technology and nutrition disciplines to promote healthy eating patterns. OBJECTIVE The main objective of this study was to design and develop a tailored nutrition application to promote healthy eating habits as a tool to support the primary care Dietetic Counselling Program. Additionally, usability study was also performed. METHODS Three focus groups were conducted with 15 primary health care professionals (Family Doctors, Nurses and Public Health and Health Promotion Technicians), Professors and Lectures of Nutrition and Food, expert users (students of the Pharmacy Degree) and Telecommunications Engineers to decide the app design and content. Additionally, for the general and feedback message design a reference model was developed bases in the scientific literature. To evaluate the relevance potential usability, acceptability, credibility, and comprehensibility of the information and interface of the app a pilot testing in a real-life environment with potential users and Health Care Professionals was carried out in four focus groups organized in four different primary health care centers. Participants included forty-two Health Professionals and users. RESULTS The SAlBi educa app developed includes an online dietary record, a self-monitoring tool to evaluate dietary patterns, general and feedback messages and traditional Mediterranean recipe examples. The reference message model included the following characteristics: length of approximately 160 characters, frequency of 1-4 messages/week, simple tone y language, personalized with the user's name and empathic to allow user empowering. More than 60 general and 65 feedback messages were designed following this model. Usability study showed that 91.7% of the participants find SAlBi educa stimulating and easy to use (87.1% of volunteers). It is worth noting that 92.3% of volunteers stated that both general and tailored nutrition messages are clear, useful (100%), relevant (97.4%) and the 86.1% agree that they have the potential to persuade people to improve their diet and physical activity. A total of 95.0% of participants would use SAlBi educa in the future and recommend. CONCLUSIONS SAlBi educa is an innovative nutritional education tool developed based on scientific evidence that has the potential to become an effective solution for supporting Nutrition Counseling in primary health care.