JMIR Publications

ABSTRACT

Background:

Food insecurity is a global public health problem. It has been anticipated that the economic recession triggered by the COVID-19 pandemic will promote an unparalleled crisis of food insecurity, affecting mainly the most vulnerable people in society, such as the elderly population. For this population, health-related behavior change is a major challenge and a reported barrier to mitigate the consequences of food insecurity. EHealth interventions represent an opportunity to promote healthy lifestyle habits in the natural context of elderly individuals. However, before their widespread dissemination, it is important to evaluate the feasibility and acceptability of end-users.

Objective:

To explore feasibility and acceptability of a home-based eHealth intervention on dietary and physical activity through an interactive TV-app to elderly people with food insecurity.

Methods:

A pilot quasi-experimental before and after study was design with baseline and 3-month follow-up assessments. A sample of food insecure elderly subjects was recruited in 17 primary healthcare centers, in Portugal. The intervention was based on a home-based intervention program through an interactive TV-app aiming to promote healthy lifestyle behaviors over 12 weeks. The primary outcomes were feasibility (self-reported usage and interest in eHealth) and acceptability (affective attitude, burden, ethically, perceived effectiveness, and self-efficacy) evaluated with a structured questionnaire using a 7-point Likert scale (1[strongly negative/completely disagree] - 7[strongly positive/completely agree]). The secondary outcomes were changes in food security (Household Food Insecurity Scale), quality of life (EuroQoL with five dimensions and three levels [EQ-5D-3L] and Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]), physical function (Health Assessment Questionnaire [HAQ], Elderly Mobility Scale [EMS], grip strength, and regularity of exercise) and nutritional status (adherence to Mediterranean diet [MD]).

Results:

A sample of 31 elderly subjects classified as having food insecurity was enrolled to the 12-week intervention program and there were no dropouts. Ten participants self-reported low-usage of TV-app. After the intervention, participants were significantly more interested in eHealth for food insecurity (baseline median[IQR]=1.0[3.0]; 3-month, 5.0[5.0];P=.01) and for other purposes (1.0[2.0];6.0[2.0];P=.03). High levels of acceptability were found both before (median[IQR] range: 7.0[2.0] to 7.0[0.0]) and after the intervention (5.0[2.0] to 7.0[2.0]), with no changes for most constructs. Clinically, there was a 40.0% reduction in food insecurity among participants (P=.001), and fatigue regarding health-related quality of life (HRQoL) (FACIT-F mean difference[SD]=-3.82[8.27];P=.02) and physical function improved (HAQ=-0.22[0.38];P=.01; EMS=-1.50[1.08];P=.01; regularity of exercise: baseline n[%]=10[32.3%]; 3-month=18[58.1%]; P=.02). No differences were found for EQ-5D-3L, grip strength, and adherence to MD.

Conclusions:

The home-based eHealth intervention showed to be feasible and highly acceptable by participants, supporting a future full-scale trial. The intervention program reduced not only the proportion of elderly people with food insecurity but also improved the participants’ fatigue regarding HRQoL and physical function.