Application of Mobile Health Technologies Aimed at Salt Reduction: Systematic Review

Abstract

Background High salt consumption has contributed to the rise of noncommunicable diseases around the world. The application of mobile health (mHealth) technologies has witnessed rapid growth in recent years. However, evidence to support mHealth interventions to confront the challenge of salt reduction has not yet been critically reviewed. Objective The aim of this study was to identify, characterize, and evaluate mHealth interventions aimed at salt reduction across the world. Methods A systematic search of studies in English or Chinese language published from January 1, 1992 to July 31, 2017 was conducted using 4 English databases (PubMed, MEDLINE, Global Health, and Cochrane) and 3 Chinese databases (Wanfang, China Science and Technology Journal, and China National Knowledge of Infrastructure). All studies directly using mobile technologies in health care with a primary or secondary objective of reducing dietary salt consumption were included. Results A total of 1609 articles were found using the search strategy, with 11 full articles (8 English and 3 Chinese) being included for data extraction, including 11 interventional studies. Overall, few high-quality interventions were identified. Most interventions were limited by small study population sample sizes, lack of control groups, and short follow-up times, all of which were obstacles in generating long-term scalable approaches. Most interventions employed short message service as a platform for mHealth interventions, whereas some innovative mHealth technologies were also explored. Most interventions had a primary focus of improving awareness of dietary salt consumption. The outcome variables used to measure intervention effectiveness included 24-hour urinary sodium excretion, spot urine sampling, dietary records, and indirect behavior or knowledge indicators targeting salt consumption. Although most interventions displayed positive outcome results, none of them provided reliable evidence to evaluate the effectiveness of salt reduction. Conclusions Salt reduction in mHealth initiatives remains relatively unexplored; however, studies that did intervene on salt-reduction show the potential of mHealth as an effective intervention method. We provide 3 recommendations for future mHealth interventions in salt reduction—(1) increased use of new, innovative, and interactive mHealth technologies; (2) development of mHealth interventions with primary prevention measures and goals of salt reduction; and (3) large-scale, rigorously designed, and object-targeted clinical trials of mHealth interventions with appropriate quantitative outcome variables, in particular 24-hour urine sodium.

Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial

“…According to the Pew Research Center’s Internet and American Life Project, 73% of the households have broadband service and 81% of the Americans (53% of them >65 years) have a smartphone [ 21 ], which supports the need for mobile app–based interventions for health care. In a recent systematic review of mobile health interventions to lower sodium intake, only 6 were randomized controlled clinical trials and only 2 of those trials were mobile app interventions published in English [ 22 ]. SaltSwitch (New Zealand) is a mobile app focused on supporting users to find food options with low sodium levels at grocery stores [ 23 ].…”

Dietitians Australia position statement on telehealth

“…Positive effects for food and nutrition outcomes have been observed when mHealth modalities are used for treatment and preventative service delivery. Systematic reviews report that app‐based mHealth interventions can improve dietary behaviours and intake of specific nutrients and foods, such as sodium (2019, n = 11 RCTs), 55 vegetables, fruit, fast food or takeaway and sugar sweetened beverage intake, as well as snacking behaviours (2016, n = 27 studies) 56 . In a meta‐analysis (2016, n = 7 studies) examining e‐ and mHealth interventions for improving fruit and vegetable intakes, the outcome favoured the treatment group (pooled effect size [Cohen's d ] 0.22, 95% CI 0.11 to 0.33; I 2 = 68.5%) 57 …”

Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: a Narrative Review of Recent Developments and Suggestions for Programmatic Efforts

“…However, while virtual public health interventions aimed at specific drivers of hypertension disparities, such as mobile health (mHealth) approaches to salt consumption reduction [ 62 •] and home blood pressure monitoring [ 63 ], had become more common even before the COVID-19 pandemic, their application has been limited in immigrant communities due to the unique socio-economic barriers faced by immigrants (e.g., limited Internet access and ownership of electronic devices to allow for video-based interfaces). However, these limitations may also pave the way for new, innovative, tailored approaches to engage with immigrants in virtual settings.…”