Behavior Change Effectiveness using Nutrition Apps in People with Chronic Disease: A Scoping Review (Preprint)

Abstract

BACKGROUND Cardiovascular disease (CVD), cancers, diabetes mellitus (DM), and obesity are commonly known chronic diseases, and their prevalence is reaching a significant epidemic level in the United States. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mHealth to access clinical information, collaborate with care teams, communicate long-distance with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved with the disease state. Hence, the available evidence on the effectiveness of mHealth apps towards behavior change to improve chronic disease outcomes is limited. OBJECTIVE The objective of this scoping review was to give an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (i.e., CVD, DM, cancer, and obesity). We further evaluated behavior change techniques and theories or models used for behavior change, if any. METHODS A scoping review was performed using a systematic literature search in Medline, EBSCO, and PubMed databases. Studies were excluded from the review if the study did not involve an app or nutrition intervention, was written in a language other than English, was a duplicate from other database searches, or if the paper was a literature review. Following the PRISMA 2020 method, the systematic review process included four steps: (1) identification of records through the databases search, (2) screening of duplicate and excluded records, (3) eligibility assessment of full-text records, and (4) final analysis of included records. RESULTS In total, 42 studies comprising 256,063 patients were included. There was diversity in the chronic disease state, study design, number of subjects, the variety of in-app features, behavioral change theories (BCTs), and behavior models used in the studies. Additionally, our review found that less than half of the studies based their nutrition app on using a behavioral theory or its constructs. Twenty-six percent (11/42) of the studies measured maintenance of health behavior change. Of these studies, 64% (7/11) sustained behavior change for approximately 6-12 months. Thirty-six percent (4/11) of these studies showed a decline in behavior change and/or discontinued app use. CONCLUSIONS The results suggest that mHealth apps involving nutrition can significantly improve health outcomes for people with chronic diseases. Tailoring nutrition apps for specific populations is recommended for effective behavior change and improvement of health outcomes. Additionally, some studies showed sustained health behavior change, and some showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of health behavior change effectiveness of disease-specific nutrition apps. CLINICALTRIAL NA