Karimi Nazgol, Crawford David, Opie Rachelle, Maddison Ralph, O'Connell Stella, Hamblin Peter Shane, Ng Ashley Huixian, Steele Cheryl, Rasmussen Bodil, Ball Kylie
Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
Diabetes & Endocrinology Centre, Sunshine Hospital, St Albans, Australia.
JMIR Res Protoc. 2020 Nov 6;9(11):e19488. doi: 10.2196/19488.
People of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group.
This study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management.
EatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program's appeal.
The EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020.
This study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget.
Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19488.
社会经济地位较低的人群受2型糖尿病（T2D）的影响尤为严重，部分原因是不健康的饮食模式导致疾病自我管理不足和预后不良。数字技术有可能提供一个合适的媒介，以促进糖尿病教育、支持自我管理，并解决该目标群体中健康饮食的一些障碍，如营养知识匮乏或购物及烹饪技能不足等问题。
本研究旨在测试EatSmart的可行性、吸引力和潜在效果。EatSmart是一个为期12周、基于证据、理论基础扎实、完全自动化的基于网络和移动设备的健康饮食行为改变计划，旨在帮助患有T2D的弱势群体在预算有限的情况下健康饮食，并改善糖尿病自我管理。
EatSmart是一项混合方法（定量和定性）的前后设计试点研究。将招募60名年龄在18至75岁之间、社会经济地位不利的T2D患者。参与者将完成关于其基本人口统计学和临床数据、饮食摄入量、饮食自我效能以及健康饮食障碍的自我报告基线评估。他们将获得EatSmart网络程序的登录权限，该程序包括六个基于技能的渐进模块，涵盖健康饮食计划；明智的食品预算和购物；省时的用餐策略、健康的烹饪方法、调整食谱；以及最后的强化和总结模块。在为期3个月的干预期间，参与者还将每周收到3条短信，鼓励他们回顾目标、继续参与EatSmart网络程序的不同部分并健康饮食。参与者将在基线后3个月的干预结束后立即进行随访评估，并在干预后6个月的随访期（基线后9个月）再次进行评估。将使用招募和保留的参与者数量以及网站参与度的客观指标来评估可行性。将通过基线时使用的相同调查问卷评估该计划的吸引力以及对主要和次要结果的潜在影响，并增加关于该计划的体验和看法的问题。干预6个月后还将进行深入的定性访谈，以更深入地了解EatSmart的体验，并更全面地描述该计划的吸引力。
EatSmart网站已开发完成，截至2020年5月，所有参与者都已查看了这些模块。预计结果将于2020年12月提交发表。
本研究将提供数据，以解决目前关于患有T2D的弱势群体是否可能从有助于在预算有限的情况下健康饮食的数字行为改变计划中受益的证据有限的问题。
澳大利亚新西兰临床试验注册中心，ACTRN12619001111167；https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167。
国际注册报告识别码（IRRID）：DERR1-10.2196/19488。
