December 18, 2019Open Access
View Full PaperFeasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial (Preprint)
Key Result
App-based diet tracking plus text message feedback did not improve DASH adherence scores over diet tracking alone (mean change 0.8 vs 0.8; P=.75) among women with elevated blood pressure.
Study Design
Type
RCT (n=59)
Randomization
randomized
Structured PICO
Does app-based diet tracking plus text message feedback improve DASH diet adherence and blood pressure in women with hypertension or prehypertension compared to app-based diet tracking alone?
P
Population
59 women with hypertension or prehypertension, mean age 49.9, 69% non-Hispanic White, 83% college educated.
I
Intervention
App-based diet tracking plus tailored feedback on DASH adherence via text message for 3 months.
C
Comparator
App-based diet tracking alone (active comparator) for 3 months.
O
Outcome
Number of days participants tracked their diet, changes in DASH adherence score, and blood pressure at 3 months.surrogate
A digital health intervention adding text message feedback to diet tracking was feasible but did not significantly improve DASH adherence or blood pressure compared to diet tracking alone in women with elevated blood pressure.
Main Result
Absolute Event Rate: 0.8% vs 0.8%
p-value: p=.75
Abstract
BACKGROUND Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (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 This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. METHODS We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) 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 included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. RESULTS The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) 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 moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. CLINICALTRIAL ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472