Effectiveness of information technology–enabled ‘SMART Eating’ health promotion intervention: A cluster randomized controlled trial

Abstract

Background Unhealthy dietary behaviour-high intake of fat, sugar, and salt, and low intake of fruits and vegetables-is a major risk factor for chronic diseases. There is a lack of evidence-based interventions to promote healthy dietary intake among Indian populations. Therefore, we tested the effectiveness of an information technology-enabled 'SMART Eating' intervention to reduce the intake of fat, sugar and salt, and to increase the intake of fruits and vegetables. Methods In Chandigarh, a North Indian city, a cluster randomized controlled trial was implemented in twelve geographical clusters, based on the type of housing (i.e., LIG: Low-income group; MIG; Middle-income group, and HIG: High-income group-a proxy for socioeconomic status). Computer-generated randomization was used to allocate clusters to intervention and comparison arms after pairing on the basis of socioeconomic status and geographical distance between clusters. The sample size was 366 families per arm (N = 732). One adult per family was randomly selected as an index case to measure the change in the outcomes. For behaviour change, a multi-channel communication approach was used, which included information technology-short message service (SMS), email, social networking app and 'SMART Eating' website, and interpersonal communication along with distribution of a 'SMART Eating' kit-kitchen calendar, dining table mat, and measuring spoons. The intervention was implemented at the family level over a period of six months. The comparison group received pamphlets on nutrition education. Outcome measurements were made at 0 and 6 months post-intervention at the individual level. Primary outcomes were changes in mean dietary intakes of fat, sugar, salt, and fruit and vegetables. Secondary outcomes

Access to Information Technologies and Consumption of Fruits and Vegetables in South Africa: Evidence from Nationally Representative Data

“…The positive and significant estimated coefficients of the information variables indicate that access to information is strongly associated with the increased frequency of F+V consumption, and the probability of consuming the minimum WHO recommended levels of F+V. These findings are consistent with the literature [8,54,55], which has reported that ownership of these communication technologies facilitates easy access to information on the health benefits of the consumption of F+V. Increased awareness of the health benefits of these foodstuffs is more likely to motivate households to consume them more than in the absence of awareness.…”

“…In South Africa, NCDs contributed to 51% of all deaths in 2016 [1]. Unhealthy diets, which involve a low intake of fruits and vegetables, on one hand, and an excess intake of fat, sugar, and salt on the other, are a major cause of diet related NCDs in many countries, including in South Africa [2,[4][5][6][7][8][9]. According to [7], the risk posed by unhealthy diets to morbidity and mortality exceeds that of the combined effect of unsafe sex, and alcohol, drug, and tobacco use.…”

“…Household visits and facilitating community dialogues are two approaches adopted by the South African government to increase health and nutrition awareness and promote healthy behaviours. While these approaches are effective, they do not reach many people and are too expensive to scale up in resource-limited settings [8,[23][24][25].…”

Medical nutrition therapy of pediatric type 1 diabetes mellitus in India: Unique aspects and challenges

“…Resource constrained medical teams can take the help of trained “parent‐educators.” Frequent contact with the patient on mobile phone or whatsapp is helpful. Mobile phones are used extensively in India and mobile calls and data are inexpensive 46,47 …”

“…Nutrition used extensively in India and mobile calls and data are inexpensive. 46,47 In India, most people have a routine meal pattern which gener-…”