Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 18, 2019
Date Accepted: Sep 12, 2020
The feasibility of a digital health intervention to improve diet quality among women with high blood pressure: Findings from a randomized-controlled feasibility trial
ABSTRACT
Background:
Over 100 million individuals have high blood pressure, and more than half are women. The 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:
To improve adherence to the DASH diet among women with hypertension or pre-hypertension.
Methods:
We conducted a 3-month randomized-controlled trial comparing app-based diet tracking (control) 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 include the number of days participants tracked diet, changes in DASH adherence score and blood pressure.
Results:
Women (N=59) had a mean (SD) age of 49.9 (11.9) years and were primarily Non-Hispanic White (69%), and college-educated (83%). The mean (SD) baseline DASH score was 2.3 (1.3). At 3 months, intervention and control participants had similar mean (SD) days tracked/week [4.2 (2.1) vs. 4.6 (2.7), p=0.54) and mean (95% CI) changes in DASH score [0.8 (0.2, 1.5) vs. 0.8 (0.4 to 1.2) p=.75). Intervention participants trended towards lower systolic (mean difference: -2.8 mmHg, 95% CI: -1.8,7.4, p=.23) and diastolic blood pressure (mean difference: -3.6 mmHg, 95% CI: -0.2,7.3, p=.07) compared to controls. Most intervention participants (79%) said they would recommend the DASH Cloud intervention to a friend or family member, however, only 34% 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 high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone, but trended towards greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Clinical Trial: This study was registered at ClinicalTrials.gov on July 12, 2017. The ClinicalTrials.gov identifier is NCT03215472. https://clinicaltrials.gov/ct2/show/study/NCT03215472?term=NCT03215472&rank=1
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