Brief report
Using Hand-Held Computer Technologies to Improve Dietary Intake

https://doi.org/10.1016/j.amepre.2008.01.034Get rights and content

Background

Portable hand-held information technology offers much promise not only in assessing dietary intake in the real world, but also in providing dietary feedback to individuals. However, stringent research designs have not been employed to examine whether it can be effective in modifying dietary behaviors. The purpose of this pilot study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing vegetable and whole-grain intake over 8 weeks in mid-life and older adults, using a randomized study design.

Methods

Twenty-seven healthy adults aged ≥50 were randomized and completed the 8-week study. Intervention participants received an instructional session and a PDA programmed to monitor their vegetable and whole-grain intake levels twice per day and to provide daily individualized feedback, goal-setting, and support. Controls received standard, age-appropriate, written nutritional education materials. Dietary intake was assessed via the Block Food Frequency Questionnaire at baseline and 8 weeks.

Results

Relative to controls, intervention participants reported significantly greater increases in vegetable servings (1.5–2.5 servings/day; p=0.02), as well as a trend toward greater intake of dietary fiber from grains (3.7–4.5 servings/day; p=0.10).

Conclusions

This study's findings provide preliminary evidence that using portable hand-held technology to provide daily individualized feedback on dietary behavior in the real world can increase the dietary intake of healthy food groups.

Introduction

Scientists have increasingly recognized the importance of greater dietary intake of vegetables and whole grains to ameliorate a wide array of chronic illnesses in U.S. adults, including cardiovascular disease, diabetes, and various cancers.1, 2, 3, 4, 5, 6 Despite the growing evidence of these benefits and the support of national programs (e.g., 5-A-Day)7 and national recommendations (e.g., the U. S. Department of Agriculture's most recent guidelines suggest that half of the cereal/bread/grain group should come from fiber-rich whole grains),2 the current intake of vegetables and whole grains is well below the recommendations, and intake levels have not increased over the past decade.8, 9 Because the health, the day-to-day functioning, and the quality of life of older adults have been shown to benefit from sound nutritional practices,10, 11, 12, 13, 14 this first-generation pilot study (Computerized Health Assessments in Real Time—Diet [CHART-D]) used a randomized experimental design to investigate the impact of a dietary intervention delivered via a personal digital assistant (PDA) on vegetable and fiber intake among older adults. The present intervention study builds on prior research showing that computer-assisted interventions improve dietary intake15, 16 as well as studies noting that PDAs can reliably assess dietary intake and behavior.17, 18, 19, 20, 21, 22

Section snippets

Study Design

Study eligibility consisted of the following: adults aged ≥50 who were able to sufficiently speak and understand English, were willing to use a PDA, and were willing to be randomized to either of the two study arms. Recruitment strategies included the promotion of the study through local community mass-media outlets (e.g., newspapers) and the distribution of study flyers in local community settings. Individuals who met initial eligibility requirements during a telephone screening underwent

Subjects

Thirty-six participants were enrolled in the study: 20 and 16 participants were randomized to the intervention and control arms, respectively (Figure 1). Four intervention participants and five control participants did not have follow-up data (FFQ) and were excluded from the analyses. Participants without follow-up data were slightly younger (p=0.01) and ate slightly less dietary fiber at baseline (p=0.06) compared to those with follow-up data; no other sociodemographic or baseline dietary

Discussion

To the authors' knowledge, this is the first study to employ a randomized study design to examine the effect of a PDA-intervention program on dietary intake. Study results are consistent with suggestions that mobile technologies can be useful tools for assessing and modifying health-promoting behaviors (e.g., healthful dietary intake).40, 41 The PDA program increased the intake of specific food groups of interest compared to standard written educational materials by focusing specifically on

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