Susan Lee. Williams

Past, present, and future of ehealth and mhealth research to improve physical activity and dietary behaviors

Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-effective interventions that can reach large populations. Electronic health (eHealth) and mobile health (mHealth) solutions have shown promising outcomes and have expanded rapidly in the past decade. The purpose of this report is to provide an overview of the state of the evidence for the use of eHealth and mHealth in improving physical activity and nutrition behaviors in general and special populations. The role of theory in eHealth and mHealth interventions is addressed, as are methodological issues. Key recommendations for future research in the field of eHealth and mHealth are provided.

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review

BackgroundHealth and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults.MethodsSystematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers.ResultsTwenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes.ConclusionsThis review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than stand-alone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy.

Increased prevalence of chronic physical health disorders in Australians with diagnosed mental illness

Objective: To compare chronic physical health disorder prevalence amongst Australian adults with and without mental illness.

Links Between Adolescent Physical Activity, Body Mass Index, and Adolescent and Parent Characteristics

Identification of the relationships between adolescent overweight and obesity and physical activity and a range of intrapersonal and interpersonal factors is necessary to develop relevant interventions which target the health needs of adolescents. This study examined adolescent body mass index (BMI) and participation in moderate and vigorous physical activity (MVPA) and their associations with school year, adolescent nutrition and sedentary behaviors, parent BMI, parent physical activity, and parent support adolescent physical activity. Participants included 295 adolescents and their parents. Logistic regression was used to examine associations between adolescent BMI, MVPA, and the range of adolescent and parent characteristics. Results indicated that parents and home environments play significant roles in the development and maintenance of adolescent overweight/obesity of physical activity behaviors. School-based interventions should ensure high levels of parent involvement and target male adolescents to reduce time spent in small screen recreation and female adolescents to increase participation in MVPA.

Characteristics of consumers using ‘better for you’ front-of-pack food labelling schemes – an example from the Australian Heart Foundation Tick

OBJECTIVE The Heart Foundation Tick aims to help consumers make healthier food choices and overcome confusion in understanding food labels. Little is known about what factors differentiate frequent from infrequent users and the effectiveness of this scheme in helping Australians make healthier food choices. DESIGN A cross-sectional survey was used to explore use of the Tick and associations with a range of individual characteristics. SETTING A national panel of Australians, living in each state and territory, completed an online survey (n 1446). SUBJECTS Adult men (41 %) and women participated in the study. RESULTS Most trusted the Heart Foundation (79 %), and used the Tick at least occasionally (19 % regularly, 21 % often, 35 % occasionally, 24 % never). A majority was classified as overweight/obese (60 %), 3·5 % were diagnosed with CHD, 5·2 % with diabetes and 23 % with hypertension. Many did not meet recommendations for the consumption of red meat (30 %), processed meat (23 %), vegetables (78 %), fruit (43 %) and fast foods (47 %). Female frequent users tended to have hypertension, be married/de facto, older than 45 years, rural dwellers, and limit their intake of fast foods. Male frequent users tended to have hypertension, meet recommendations for fruit, vegetables and processed meats, but not have a tertiary education. CONCLUSIONS The Heart Foundation Tick is a highly trusted, highly recognizable food labelling scheme and helpful to consumers who are motivated to make healthier food choices. More inter-sector collaboration is required to incorporate these schemes into public health campaigns to help consumers make healthier food choices.

We Can Do That! Collaborative Assessment of School Environments to Promote Healthy Adolescent Nutrition and Physical Activity Behaviors.

Evidence for effectiveness of school-based studies for prevention of adolescent obesity is equivocal. Tailoring interventions to specific settings is considered necessary for effectiveness and sustainability. The PRECEDE framework provides a formative research approach for comprehensive understanding of school environments and identification of key issues/areas to focus resources and energies. No reported studies have tested applicability of the PRECEDE framework in schools in relation to obesity. Adolescents (n = 362), parents (n = 349) and teachers (n = 146) from six secondary schools participated in two quantitative studies and two qualitative studies. Data collected from these studies permitted confirmation of adolescent overweight/obesity a health issue for schools; the need for secondary schools to focus health promotion efforts on healthy nutrition, with inclusion of parents/homes and appreciation for gender differences in developing interventions. Community buy-in and commitment to school-based obesity prevention programs may be dependent on initially addressing what may be perceived as minor issues, and developing policies to guide practices within schools in relation to supply and access to healthy foods, use of sporting equipment and participation in physical activities. The PRECEDE framework allows systematic assessment of school environments and provided opportunity to identify realistic and relevant interventions for promoting healthy adolescent physical activity and nutrition behaviors.

Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis

Background Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. Objective The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet. Methods The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). Results The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. Conclusions This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field.

A review of probiotic supplementation in healthy adults: helpful or hype?

Probiotic supplements have a positive impact on several health outcomes. However, the majority of published studies have focused on populations with specific health pathologies. Therefore, this study reviewed the current literature on the health effects of probiotic consumption in “healthy adults.” The findings from this review may help guide consumers, researchers, and manufacturers regarding probiotic supplementation. Relevant literature published between 1990 and August 2017 was reviewed. Studies were included if they were experimental trials, included healthy adults, used live bacteria, and had accessible full-text articles published in English. Included studies were classified according to common foci that emerged. Forty-five studies were included in this review. Five foci emerged: gut microbiota changes (n = 15); immune system response (n = 16); lipid profile and cardiovascular disease risk (n = 14); gastrointestinal discomfort (n = 11); and female reproductive health (n = 4). Results suggest that probiotic supplementation in healthy adults can lead to transient improvement in gut microbiota concentration of supplement-specific bacteria. Evidence also supports the role of probiotics in improving immune system responses, stool consistency, bowel movement, and vaginal lactobacilli concentration. There is insufficient evidence to support the role of probiotics to improve blood lipid profile. Probiotic consumption can improve in the immune, gastrointestinal, and female reproductive health systems in healthy adults. However, this review failed to support the ability of probiotics to cause persistent changes in gut microbiota, or improve lipid profile in healthy adults. The feasibility of probiotics consumption to provide benefits in healthy adults requires further investigation.

Measuring engagement in e- & mHealth behaviour change interventions: a methodological overview (Preprint)

Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.

Optimized daily diet composition for a nutritionally balanced diet: An application of Fuzzy Multiple Objective Linear Programming

Nutrition related diseases such as Cardiovascular Diseases, type 2 diabetes, and certain types of cancers are widely prevalent, and increasing in both developed and developing countries. This escalates the need to consistently follow a nutritionally balanced diet. Formulation of nutritionally balanced Meals is a complex task, which requires considerable effort, time, and intellectual capability for evaluation of Menu items and analysis of a range of nutrient values. As a step towards automating this task, this interdisciplinary study presents a fuzzy optimization model applying Fuzzy Multi-objective Linear Programming (FMOLP) to compose a daily diet consisting of nutritionally balanced Meals which limit nutrients such as cholesterol, sugar, saturated fat, and sodium. An effective algorithm is developed to create a pare to optimal solution set of optimized daily diet choices. The model is tested using one hundred Menu items, for demonstrating the applicability of the model in composing a nutritionally balanced diet.