Effectiveness of a Smartphone App (e-12HR) in Improving Adherence to the Mediterranean Diet in Spanish University Students by Age, Gender, Field of Study, and Body Mass Index: A Randomized Controlled Trial

Béjar, Luís; Mesa-Rodríguez, Pedro; Quintero‐Flórez, Angélica; Ramírez-Alvarado, María del Mar; García-Perea, María Dolores

doi:10.3390/nu15071688

Cited by 3 publications

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“…As previously mentioned, the e-12HR app has also been evaluated among Spanish university students (health sciences and non–health sciences) [ 19 , 20 ]. In relation to the main objective, the results obtained by the e-12HR app among PCPs compared to university students were (1) similar for the MDSS index (the increase among PCPs was 25.6% for the MDSS index, as shown in Table 2 , and among university students was 17.4% [ 19 ] or 25.7% [ 20 ]), (2) more positive for the number of participants with a medium/high MDSS index (the increase among PCPs was 213.1%, as shown in Table 2 , and among university student was 61.9% [ 19 ] or 74.5% [ 20 ]), and (3) less positive regarding the number of participants meeting the recommendations for specific food groups (improvements in 4 food group among PCPs, as shown in Table 4 , and in 7 food groups among Spanish university students).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the secondary objectives, first, similar results were obtained among Spanish university students for the answers to the questions of the usability rating questionnaire for the e-12HR app. Second, at baseline (week 1), the mean MDSS index of 9.45 (SD 2.32) and the number of participants with a medium/high MDSS index (66%) among PCPs ( Table 1 ) were higher compared with the data from health sciences students [ 20 ] during the same follow-up period (mean MDSS index 7.59, SD 2.72; percentage of participants with a medium/high MDSS index=33.4%). Significant statistical differences were found ( P <.05) for both the MDSS index, which was evaluated with the Mann-Whitney U test, and the number of participants with a medium/high MDSS index, which was evaluated with the chi-square test: PCPs showed an improvement of 24.5% for the MDSS index and 98.2% for the number of participants with a moderate/high MDSS index (PCPs vs health science university students).…”

Section: Discussionmentioning

confidence: 99%

“…The research team has previously evaluated the effectiveness of a smartphone app called the Electronic 12-Hour Dietary Recall (e-12HR) in improving diet in Spanish university students (health science [ 19 , 20 ] and non–health science [ 20 ]). The main hypothesis of this study was that the use of this app among PCPs can have an influence on improving their diet, as has already been evidenced in previous research among university students [ 19 , 20 ], the null hypothesis being that the use of the app has no influence on improving the diet of PCPs.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial

Béjar,

Mesa-Rodríguez,

García-Perea

2024

JMIR Mhealth Uhealth

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Background The World Health Organization has called for addressing the growing burden of noncommunicable diseases (NCDs) by promoting healthy lifestyles among the population. Regarding patient health, primary care professionals (PCPs) are the first line of care who can positively influence patients’ behavior and lifestyle habits. However, a significant percentage of PCPs do not lead a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. The Mediterranean diet has been extensively studied, and there is strong evidence of it being a dietary pattern for the prevention of NCDs, in addition to its significant environmental, sociocultural, and local economics benefits. Objective This study focused only on the dietary aspect of the PCPs’ lifestyle. The primary objective was to evaluate the effect of using the Electronic 12-Hour Dietary Recall (e-12HR) smartphone app to improve diet, specifically to promote adherence to the Mediterranean diet (AMD), among PCPs. The secondary objectives were to establish the usability of the e-12HR app and to determine AMD among PCPs. Methods An individual-level randomized, controlled, and single-blind clinical trial was conducted with 2 parallel groups: a control group (CG), using the nonfeedback version of the e-12HR app, and an intervention group (IG), using the feedback version of the e-12HR app. The level of human involvement was fully automated through the use of the app. There was a 28-day follow-up period. Participants were PCPs (medicine or nursing) recruited offline at one of the selected primary care centers (Andalusia, Spain, Southern Europe), of both sexes, over 18 years old, possessing a smartphone, and having smartphone literacy. Results The study response rate was 73% (71 of 97 PCPs), with 27 (38%) women and 44 (62%) men: 40 (56%) PCPs in the CG and 31 (44%) in the IG. At baseline, AMD was medium (mean Mediterranean Diet Serving Score [MDSS] index 9.45, range 0-24), with 47 (66%) PCPs with a medium/high MDSS index. There were significant statistical improvements (CG vs IG, in favor of the IG) at week 4 (no significant statistical differences at baseline): +25.6% for the MDSS index (P=.002) and +213.1% for the percentage with a medium/high MDSS index (P=.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8%, P=.02), vegetables (+352%, P=.001), nuts (+184%, P=.02), and legumes (+75.1%, P=.03). The responses to the usability rating questionnaire were satisfactory. Conclusions The results support recommending the use of the e-12HR app as a tool to contribute to improving diet and preventing NCDs among PCPs, while positively influencing patient dietary behavior and preventing diet-related NCDs among patients. Trial Registration ClinicalTrials.gov NCT05532137; https://clinicaltrials.gov/study/NCT05532137

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial

Béjar,

Mesa-Rodríguez,

García-Perea

2024

JMIR Mhealth Uhealth

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Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial (Preprint)

Béjar¹,

Mesa-Rodríguez²,

Garc�a-Perea³

2023

Preprint

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BACKGROUND The World Health Organization has called for addressing the growing burden of non-communicable diseases (NCDs) by promoting healthy lifestyles among the population. Healthcare workers are a subgroup of the population where lifestyle promotion is essential for three main reasons: for their own health, for the success of healthcare organizations, and for patient health. Regarding this last point (about patient health), primary care professionals (PCPs) are the first line of care that can positively influence patients' behavior and lifestyle habits. However, PCPs, do not have a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. This study focused only on the dietary aspect. OBJECTIVE Primary objective, to evaluate the effect of using the e-12HR app to improve diet (specifically, to promote adherence to the Mediterranean diet (AMD)) among PCPs. The Mediterranean diet has been extensively studied and there is strong evidence of it being a dietary pattern for the prevention of NCDs, besides its significant environmental, sociocultural and local economics benefits. Secondary objectives, to establish the usability of e-12HR and determine AMD among PCPs. METHODS Individual-level randomized, controlled and single-blind clinical trial with two parallel groups: control group (CG), using the ‘non-feedback’ version of e-12HR, and intervention group (IG), using the ‘feedback’ version of e-12HR. 28-day follow-up period. Participants were PCPs (medicine or nursing) at one of the selected primary care centers (Andalusia, Spain, Southern Europe), both genders, over 18 years-old and possess a Smartphone. RESULTS 71 participants (47 doctors and 24 nurses), 38.0% women and 62.0% men: 40 in the CG and 31in the IG. At baseline, the AMD was medium (mean index of 9.45 and with the 66.2% of participants with medium/high index). There were significant statistical improvements (CG versus IG, in favor of the IG) at week four (no significant statistical differences at baseline): +25.6% for the AMD index (P value = 0.002) and +213.1% for the percentage with medium/high AMD index (P value = 0.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8%, P value = 0.022), vegetables (+352.0%, P value = 0.001), nuts (+184.0%, P value = 0.022) and legumes (+75.1%, P value = 0.028). The responses to the usability rating questionnaire for e-12HR were very satisfactory. CONCLUSIONS The results support recommending the use of e-12HR as a tool to contribute to improving diet and preventing NCDs among these PCPs (which, at the same time, could positively influence patient dietary behavior and prevent diet-related NCDs among those same patients). CLINICALTRIAL ClinicalTrials.gov, NCT05532137.

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Adherence to the Mediterranean Diet in Association with Self-Perception of Dietary Behavior (Discrepancy between Self-Perceived and Actual Diet Quality): A Cross-Sectional Study among Spanish University Students of Both Genders

Béjar

2024

Nutrients

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Background/Objectives: The Mediterranean diet (MD) is one of the most studied dietary patterns to date and is associated with multiple benefits for health and sustainability. However, paradoxically, adherence to the MD (AMD) has been gradually decreasing in native regions. It is necessary to identify the factors that influence AMD to reverse this trend and to mitigate the negative outcomes (for health and the environment) associated with westernized diets. The objective of this study was to assess how self-perception of dietary behavior influences AMD. Methods: During the 28-day repeated measurement cross-sectional study, participants’ dietary information was obtained from an initial form which established the self-perception of dietary behavior and the e12HR application to establish actual food consumption by individuals. Using the dietary information from both sources, the AMD index was calculated (specifically, the Mediterranean diet Serving Score (MDSS) index). Two categories of self-perception of dietary behavior were defined: Normal/underestimation: difference (MDSS index from initial form—MDSS index from e12HR application) ≤0; and Overestimation: difference >0 (with three subcategories: low (difference = 1–5), moderate (difference = 6–10), high (difference = 11–15)). Results: 139 (111, women; 28, men) Spanish university students were studied, with 98.6% (99.1%, women; 96.4%, men) falling into the overestimation category (they overestimated their dietary behavior); these students had significantly lower MDSS indexes, mean = 6.7, than students in the normal/underestimation category, mean = 12.0. Within the overestimation category, there were significant differences in the MDSS index: low (mean = 8.1), moderate (mean = 6.7), and high (mean = 4.9) subcategories and also differences that were significant in women but not in men. Conclusions: Overestimation of dietary behavior could be associated with lower AMD in all Spanish university students and women.

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Effectiveness of a Smartphone App (e-12HR) in Improving Adherence to the Mediterranean Diet in Spanish University Students by Age, Gender, Field of Study, and Body Mass Index: A Randomized Controlled Trial

Cited by 3 publications

References 47 publications

Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial

Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial

Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial (Preprint)

Adherence to the Mediterranean Diet in Association with Self-Perception of Dietary Behavior (Discrepancy between Self-Perceived and Actual Diet Quality): A Cross-Sectional Study among Spanish University Students of Both Genders

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