Does the use of mobile applications or mobile health technology improve diet quality in adults? A protocol for a systematic literature review

Introduction

A healthy, varied, and balanced diet is integral in the promotion of health and wellbeing¹. Research investigating the value of diet quality has indicated that improving diet quality shows a more significant reduction in chronic disease². Much research has been conducted to determine methods to measure diet quality, which has led to the development of a number of indices. These indices allow for the evaluation of dietary patterns appraising the selection of specific foods, compliance with nutritional recommendations, and chronic disease risk. The use of diet quality indices has now become best practice in updating dietary recommendations aimed at reducing the risk of chronic disease by improving the nutritional profile of the individual^3–5.

Mobile technology and our daily interactions with mobile applications are growing exponentially. Globally, it is believed there were at least 2700 million smartphone users in 2019 and about 1400 million tablet owners⁵. Consequently, integrating mobile technology into our daily habits has triggered changes in the way we live, work, communicate and connect socially^5,6.

In the field of diet and nutrition, the availability and popularity of nutrition software applications for mobile devices have increased⁷. Specific applications on the Google Play Store reported 50 to 100 million installations of nutrition and physical activity-monitoring applications in April 2017⁸. Dietary mobile applications offer many attractive features for those who use them; they are easy to access, usually low cost/free of charge and offer users various app-based support features including behavioural or social interactions^8,9. The rise in smartphone users globally has led to the rise and development of information and communication technology-based health care for nutritional education to prevent and treat chronic disease¹⁰. Mobile health technology or mhealth is described as innovative information and communication technology and is the umbrella term for which all mobile health device and applications, which are used to provide health services using the capabilities of mobile technology (i.e., mobile phones) for reporting health information, monitoring clinical signs, and enabling direct supervision and instruction^10–12. The use of mobile applications and mHealth technology can have positive implications for clinicians such as dietitians and registered nutritionists who examine data such as the nutritional quality of a patient's or client's diet using the data inputted into mobile applications^12,13 to then give personalised nutritional advice or tailor dietary plans to meet the specific needs of the individual. Indeed some applications have a live input option and can offer a practical alternative to food frequency questionnaires; therefore, the data from such applications has been shown to be more reliable and user-friendly compared to 24-hour recalls^14,15. The applications have also been shown to positively impact users' behaviours, which was defined as 'any activity undertaken to prevent or detect disease or improve the user's health and well-being¹⁶.

Mobile technology-assisted dietary assessment currently exists to collect dietary data and allows for real-time recording of food intake. The recording of diet with mobile technology offers a unique opportunity to capture information that is not being recorded using traditional methods, such as the quality of food being consumed¹⁷. It has been reported that user satisfaction was high for dietary assessment applications, with the majority of participants preferring mobile phone dietary assessment methods to conventional methods as they provide real‐time feedback on energy and nutrient intake^18–20. These applications are likely to evolve and develop further in the future; with healthcare, linking to devices with biological information²¹.

mHealth and mobile devices provide a unique vehicle for collecting dietary information²². Furthermore, mobile devices and applications have been reported to improve patient and client health with noticeable improvement in diet and dietary behaviour^22,23. Such applications benefit behaviour by offering an 'early warning system' to allow individuals self-monitor their diet daily. Weight loss has been one of the highlighted outcomes from using mobile applications in a health care setting^22,23. Indeed, mobile applications are also used to treat certain medical conditions by allowing patients track their diet and measure specific health outcomes. Conditions such as diabetes, epilepsy and chronic disease in the elderly can be effectively managed using mobile applications^23–25. While there is a variety of research available which highlights the benefits of mobile applications to improve diet related and patient outcomes, none to date have examined the impact of mobile applications on the quality of food consumed.

Methods

This protocol has been prepared following the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines as shown in the PRISMA-P checklist (see Reporting guidelines)²⁶. The protocol has been registered with the international prospective register of systematic reviews (PROSPERO) database for registration CRD42021240224 (01/03/2021).

Ethics and dissemination

This systematic review involves secondary analysis of currently existing data and will not need ethical approval. The results of this research will be submitted for peer-reviewed publication in an open-access academic journal and presented at relevant conferences.

Amendments to protocol

All changes will be reported to PROSPERO should the protocol be amended.

Study status

The study is currently ongoing. The expected end date for the study is March 2022.

Conclusion

The proposed systematic review will examine existing evidence to highlight the effects of using mobile applications on diet quality. Results from this systematic review may inform and facilitate the use of mobile health dietary based technology for both individuals and clinicians who wish to use technology to show an improvement in their diet quality and assess against other health based outcome measures of interest.

Data availability