Increasing nutrition intervention accessibility and efficacy through web app development and dietitian partnerships

Oliveira, Ashleigh Lauren

Permalink

https://hdl.handle.net/2142/129387 Copy

Description

Title

Increasing nutrition intervention accessibility and efficacy through web app development and dietitian partnerships

Author(s)

Oliveira, Ashleigh Lauren

Issue Date

2025-04-15

Director of Research (if dissertation) or Advisor (if thesis)

Nakamura, Manabu T

Doctoral Committee Chair(s)

Nickols-Richardson, Sharon

Committee Member(s)

• Hodge, Krystal
• Liechty, Janet

Department of Study

Nutritional Sciences

Discipline

Nutritional Sciences

Degree Granting Institution

University of Illinois Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• dietitians
• weight management
• obesity
• app development
• weight loss
• nutrition interventions
• semaglutide
• protein
• fiber

Abstract

Introduction In 2016, half of adults in the United State (US) had one or more chronic diseases associated to poor diet such as cardiovascular disease, diabetes, hypertension, dyslipidemia, osteoarthritis, sleep apnea, some types of cancer, and infertility. Excess adiposity is a major contributor to diet associated disease due to inflammatory side effects of lipotoxicity. There are many approaches to treatment, but for those where diet is a factor to onset of disease, a change to diet and lifestyle is pertinent to sustainable, long-term resolution. Registered dietitian nutritionists (RDNs) are the primary interventionists prior to more invasive measures such as pharmacotherapy and bariatric surgery; however, many individuals lack access to adequate healthcare, especially underserved populations in rural or low-income communities of the US. The objective to this research is to develop tools to reach underserved adults with nutrition interventions by qualified professionals and to gather feedback from patients and providers on their feasibility and acceptability. Methods A protein-fiber plot (PF Plot) used in prior studies was an effective tool for teaching participants to select a nutrient dense, calorically balanced diet. To make the PF plot into a more accessible intervention, a web application, MealPlot, was developed and tested in collaboration with the Applied Research Institute, College of Engineering, University of Illinois. Version 1.0 of the app was developed based on behavior change techniques and tested in a clinical weight loss trial (N=30) from which Version 2.0 was developed and tested (N=11) for feasibility and acceptability. Version 3.0 was developed following user group tested by scientists and developers in a 3-month review (N=11). A one-year clinical trial was completed (N=16) using the MealPlot web application and EMPOWER online weight loss program to test feasibility and acceptability of using an online program and app in an underserved, rural population. EMPOWER is a weight management program that includes video education sessions and homework in an eText workbook, dietitian led counselling sessions, and self-monitoring and nutrition intervention through the MealPlot app. Participants with BMI ≥ 25 were enrolled with the assistance of Extension educators in rural counties of Illinois. Feasibility was measured by enrollment, retention, and completion of education sessions and anthropometric and dietary measures. Acceptability was measured by Likert scale surveys of satisfaction on program components. A survey was created and distributed to RDNs (N=739) of the Weight Management Dietetic Practice Group of the Academy of Nutrition and Dietetics to gain a better understanding of weight loss programs and tools that are being used in practice and where an online program and app may have benefit to providers and patients. The survey contained 33 questions and four domains (current practice diet interventions and protocols, client demographics, practitioner demographics, and barriers) and results were analyzed using descriptive statistics. In the final study, RDNs were recruited to review the content of the online EMPOWER program and MealPlot web application over the course of 3 months and provide their feedback on the practicality and usefulness of such tools as these in their practice. Thematic coding analysis with Atlas.ti (Ver 9.1.4) was used to organize and interpret interview transcriptions. Results A fully developed web application, MealPlot, resulted for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. Version 1.0 was used successfully to provide a functioning, interactive weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8/11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. The EMPOWER program and MealPlot application were used in the EMPOWER Rural program assessing its feasibility and acceptability by underserved, rural patients. EMPOWER Rural achieved its goal enrollment, however due to higher than anticipated dropout (retention 62.5%, N=10) at 3-months, 62.5% of the education sessions and 75.0% of anthropometric and dietary measures were completed. The average satisfaction rating for the comprehensive program was 4.2/5 (N=11). On average a clinically significant (≥ 5% baseline weight) weight loss of 6.2±6.0 % body weight or 5.7±5.3 kg and improvements to protein and fiber intake at 12 months (N=10) were observed. Healthcare providers, RDNs (N=739), surveyed on facilitators and barriers to providing weight loss coaching in their current practices indicated that app use was their most common method of food record collection (n=299) and that while online resources and apps were prevalently used, there was a reported lack of standard programs and resources for practitioners and patients to refer to. Additionally, patient retention was a commonly cited barrier to success (n=253). Twenty-two RDNs completed the 3-month review of the online EMPOWER program and MealPlot app and were interviewed on their perceptions of using these tools. Perceived barriers to implementation included a lack of client’s available time, self-motivation, insurance coverage, and education as well as infrastructural barriers limiting the ability to adopt new programs. Perceived facilitators included a preexisting demand from their clients for online resources and apps and a possible increase in client accountability and self-monitoring through use of these technologies. Additionally, RDNs indicated using these tools could help spare them time on looking for resources and educating clients. Conclusion The web application, MealPlot was developed to use in partnership with an online weight loss program, EMPOWER for consistent guidance that is not otherwise available in a traditional in-person health care setting. EMPOWER and MealPlot showed adequate to strong feasibility and acceptability among a pilot sample (N=16) of underserved rural residents. Surveyed RDNs (N=739) providing weight management services indicated that online platforms and apps are common in dietetic practice but that there is a lack of reliable resources for RDNs to refer clients to and that accurate food record collection and client attrition remains a challenge. In the final study, 22 RDNs indicated an online weight loss program and app to be potentially valuable to both the patient and provider for increasing accountability, self-monitoring, and efficiency. Identified barriers in this study provide guidance on how to make online weight loss programs more acceptable, valuable, and effective for RDNs and their clients.

Graduation Semester

2025-05

Type of Resource

Thesis

Handle URL

https://hdl.handle.net/2142/129387

Copyright and License Information

Copyright 2025 Ashleigh Oliveira

Owning Collections