Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial

Abstract

Background Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472

Implementation of an At-home Blood Pressure Measurement Protocol in a Hypertension Management Clinical Trial During the COVID-19 Pandemic

“…With 85% of the US population owning a smartphone and 77% having home broadband, 25 it is becoming increasingly feasible for research teams to consider remote recruitment and data collection procedures. Our team chose to make all intervention components accessible via smartphone to facilitate research with traditionally hard-to-reach populations, including individuals with lower income and lower education who are more likely to be smartphone-dependent for Internet access 23 . These implications extend to clinical settings, where remote protocols offer the opportunity for telehealth visits or at-home monitoring to replace or complement in-person clinic visits.…”

“…Our team chose to make all intervention components accessible via smartphone to facilitate research with traditionally hard-to-reach populations, including individuals with lower income and lower education who are more likely to be smartphone-dependent for Internet access. 23 These implications extend to clinical settings, where remote protocols offer the opportunity for telehealth visits or at-home monitoring to replace or complement in-person clinic visits. The asterisk (*) indicates an adverse event would be documented.…”

The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review

“…Of the 5 included studies, 3 were conducted in the United States [31][32][33] and 2 in Iran [34,35]. All were published between 2017 and 2021 (Multimedia Appendix 3).…”

“…Of the 5 studies, 3 were RCTs [33][34][35] and 2 were pre-post pilot studies [31,32]. In terms of duration, the interventions were commonly conducted for 3 to 6 months [31][32][33][34][35].…”

“…All studies supported self-management of the DASH diet and hypertension. They all aimed to enhance self-management with increased patient awareness through educational information [31][32][33][34][35]. One study enhanced self-management without involving a human coach to monitor patients remotely [35], whereas the remaining 4 studies aimed to enhance self-management by involving a human coach [31,32] or research team to monitor patient data and health status remotely [33,34].…”