Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
J Med Internet Res. 2021 Aug 31;23(8):e26871. doi: 10.2196/26871.
Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users.
This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity.
A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet).
A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean -3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean -0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean -1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet.
The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants' fatigue and physical function.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.6626.
食品不安全是一个全球性的公共卫生挑战，主要影响社会中最脆弱的人群，包括老年人。对于这一人群，电子健康干预代表了促进健康生活习惯的机会，从而减轻食品不安全的后果。然而，在广泛传播之前，评估这些干预措施在最终用户中的可行性和可接受性至关重要。
本研究旨在探索一种基于家庭的电子健康干预措施的可行性和可接受性，该措施通过互动电视（TV）应用程序专注于改善饮食和身体活动，以改善食品不安全的老年人的健康。
设计了一项非对照准实验性研究，包括基线和 3 个月的随访评估。从葡萄牙的 17 个初级保健中心招募了患有食品不安全的老年参与者。实施了一项基于家庭的干预计划，使用互动电视应用程序，旨在促进健康的生活方式行为，为期 12 周。主要结果是可行性（自我报告的电子健康使用和兴趣）和可接受性（情感态度、负担、道德、感知效果和自我效能），使用 7 点李克特量表的结构化问卷进行评估。次要结果是食品不安全（家庭食品不安全量表）、生活质量（欧洲生活质量问卷，五维度和三水平和慢性疾病治疗疲劳的功能评估）、身体功能（健康评估问卷、老年人移动性量表、握力和运动规律）和营养状况（地中海饮食的依从性）的变化。
共有 31 名患有食品不安全的老年个体参加了为期 12 周的干预计划，没有中途退出。共有 10 名参与者自我报告电视应用程序使用频率低。干预后，参与者对使用电子健康改善食品不安全（基线中位数 1.0，IQR 3.0；3 个月中位数 5.0，IQR 5.0；P=.01）和其他目的（基线中位数 1.0，IQR 2.0；3 个月中位数 6.0，IQR 2.0；P=.03）的兴趣明显增加。干预前后的可接受性水平都很高（中位数范围为 7.0-7.0，IQR 2.0-0.0 和 5.0-7.0，IQR 2.0-2.0，分别），大多数结构没有显著变化。临床方面，食品不安全程度降低了 40%（P=.001），疲劳减轻（平均-3.82，SD 8.27；P=.02），身体功能改善（健康评估问卷：平均-0.22，SD 0.38；P=.01；老年人移动性量表：平均-1.50，SD 1.08；P=.01；运动规律：基线 10/31，32%；3 个月 18/31，58%；P=.02）。欧洲生活质量问卷五维度和三水平、握力或地中海饮食的依从性没有差异。
基于家庭的电子健康干预措施对参与者是可行和高度可接受的，因此支持未来的全面试验。该干预计划不仅降低了老年人食品不安全的比例，而且改善了参与者的疲劳和身体功能。
