Date Published: April 3, 2019
Publisher: Public Library of Science
Author(s): Rosalind Fallaize, Rodrigo Zenun Franco, Faustina Hwang, Julie A. Lovegrove, Manuel Portero-Otin.
Nutrition apps have great potential to support people to improve their diets, but few apps give automated validated personalised nutrition advice. A web app capable of delivering automated personalised food-based nutrition advice (eNutri) was developed. The aims of this study were to i) evaluate and optimise the personalised nutrition report provided by the app and ii) compare the personalised food-based advice with nutrition professionals’ standards to aid validation. A study with nutrition professionals (NP) compared the advice provided by the app against professional Registered Dietitians (RD) (n = 16) and Registered Nutritionists (RN) (n = 16) standards. Each NP received two pre-defined scenarios, comprising an individual’s characteristics and dietary intake based on an analysis of a food frequency questionnaire, along with the nutrition food-based advice that was automatically generated by the app for that individual. NPs were asked to use their professional judgment to consider the scenario, provide their three most relevant recommendations for that individual, then consider the app’s advice and rate their level of agreement via 5-star scales (with 5 as complete agreement). NPs were also asked to comment on the eNutri recommendations, scores generated and overall impression. The mean scores for the appropriateness, relevance and suitability of the eNutri diet messages were 3.5, 3.3 and 3.3 respectively.
Nutrition apps have significant potential to improve health-related food choice. However, our review of popular nutrition-related mobile apps revealed that none of the reviewed apps had a decision engine capable of providing personalised dietary advice . Despite this, a recent three country study (Australia, New Zealand and the UK) showed that nutrition apps were used by the majority of the respondent dietitians (62%, n = 570), as information sources (74%) or for patient self-monitoring (60%) . These data illustrate the high and increasing use of nutrition-related apps by both the public and dietetic professionals. There is a lack of evidence on whether users of nutrition apps are able to understand them (including design, data visualisation, messages) and whether nutrition professionals (NP) agree with the information and advice provided by them.
Ethical approvals for the formative and NP studies were granted by the Research Ethics Committee of the School of Chemistry, Food and Pharmacy at the University of Reading, UK (Ref No. 04/17 and 11/17, respectively).
The interest in diet apps from both the public  and NP  reinforces the importance of studies that evaluate the suitability of dietary advice that is delivered by the apps. The participants of the formative and the NP studies confirmed that the diet messages (texts) were clear and highlighted the benefit of using a traffic light system in the data visualisation. They reported good understanding of the diet messages, which was in a large part due to the clear food-based recommendations, instead of advice that focused on nutrients, which are difficult to translate to dietary changes. Furthermore, practical advice on food swapping was given that facilitated easy application of the personalised advice to everyday food choice. The evaluation of appropriateness, relevance and suitability of the eNutri advice by the NP indicate a good acceptance by this group.
Evaluation of novel health-related applications by service users and expert stakeholders is vital to ensure the appropriateness, relevance and suitability of advice given. In the present study, a number of improvements to the eNutri personalised nutrition application’s diet advice were suggested by nutrition professionals including: greater participant profiling (e.g. weight and lifestyle), links to recipes and sources of further information, consideration of additional foods/nutrients of public health relevance (e.g. vitamin D), and more positive message framing/scoring. Future research will assess the efficacy of the system at improving user’s adherence to healthy eating guidance.