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)

Abstract

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.