EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study

Abstract

Background People of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. Objective This study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. Methods EatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. Results The EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. Conclusions This study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 International Registered Report Identifier (IRRID) DERR1-10.2196/19488

The Development and Validation of the Planning to Make Meals Performance Measure

“…Food can be both a powerful way to connect to people and a means to promote individual interest in self-care (Pettinger et al, 2017). Current programs seeking to decrease the negative health consequences caused by obesity or diabetes often strive to enhance cooking and food-related skills (Alpaugh et al, 2020; Karimi et al, 2020) but rely on self-report measures to capture changes in skill level. In addition, individuals with schizophrenia as well as the aging population have been identified as at risk for health problems due to food- and cooking-related challenges (Hamera & Brown, 2000; Plastow et al, 2014).…”

Participants’ and Health Care Providers’ Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study

“…EatSmart, a 12-week, multimodality-delivered healthy eating intervention, included access to a website viewable on mobile devices or PCs and tailored SMS text messages designed for disadvantaged people with T2D. This intervention is described in detail in the protocol paper [ 21 ] and summarized in this section. The website consisted of 6 skill-based modules provided to participants on a 2-weekly basis and that covered various topics such as the importance of vegetable, fruit, and whole food intake for health and diabetes; smart shopping planning and food label reading; modification of recipes by trying and incorporating new types of vegetables; improvement of cooking skills and confidence; and a final reinforcement and summary module.…”

“…Individuals who are pregnant or breastfeeding, those with visual or hearing impairment, and those who had an eating disorder with special medical or dietary requirements, clinical depression, planned surgery, or plans for long travel during the study period were not invited to the program. The inclusion and exclusion criteria have been fully described in the study protocol [ 21 ].…”

A co-designed website (FindWays) to improve mental health literacy of parents of children with mental health problems: protocol for a pilot randomised controlled trial

“…Feasibility trials typically involve 20-100 participants, and evaluate the suitability of outcome measures, participant acceptance of the intervention (recruitment and retention rates) and DHI usage (e.g. adherence) [28][29][30][31][32]. From our systematic review of five included studies, we found single cohort trials limited the strength of evidence of effectiveness as this methodology is inherently prone to confounding bias [33].…”