Using a mobile health software in improving diet quality and physical activity and nutrition status among youth in Nairobi, Kenya

Abstract

Introduction: Socioeconomic transitions globally and in Kenya have an influence on lifestyles including dietary choices and physical activity. These changes can be linked to increasing trends in morbidity and mortality associated with overweight, obesity and non-communicable diseases (NCDs) such as diabetes and cardiovascular disease. Key prevention strategies include being physically active and eating a healthy diet. Several strategies have been employed tackle the problem including the use of innovative m-health (MH) technology. However, the application of these technologies in developing countries such as Kenya is limited. Objective: The purpose of this study was to determine whether the use an MH software could improve diet quality and physical activity and consequently lead to weight-loss among youth aged 18-35 years living in Nairobi. Methods: A randomized controlled trial approach was adopted; where baseline data on diet quality, physical activity (PA) levels, Basal Metabolic Index (BMI) and waist circumference (WC) was collected, and follow-up data after s i x a n d t welve weeks. Young adults with no apparent underlying condition deemed unsafe for the study, with BMI>24.9KgM-2 aged 18 to 35 years from 5 institutions of higher learning were recruited (N=72; male=12, female=60). Subjects were solicited by volunteerism. Participants were randomly allocated into either the experimental (app) or control (diary) groups by tossing a coin. Diet quality was assessed using the Rapid Eating Assessment for Patients-short version (REAP-S), while physical activity was measured using the International Physical Activity Questionnaire (IPAQ) and weight- loss was assessed using BMI and WC. Baseline and follow-up means were compared using independent t-Test between groups and repeated measures ANOVA within groups. Relationship between app or diary use and improved diet quality, physical activity and nutritional status was examined using multiple linear regression. P < 0.05 was considered significant. Results: There was a statistically significant improvement in diet quality (REAP-S P=0.001) and physical activity (MET-Min/Week P=0.001) for participants using the app at the 6 th week. However, this was not sustained up to the 12 th week (REAP-S P=0.33; MET-Min/Week P=0.18). Although participants using the app lost weight, the difference was not statistically significant when compared to those in the control at both 6 and 12 weeks (WC P=0.300; BMI P=0.070) and (WC P=0.38: BMI P=0.18) respectively. Multiple regression analyses also revealed adherence to the app did not significantly predict improvement in diet quality (REAP-S: β=0.46 t (70) = 0.372, ns) and physical activity (MET-min/week: β=-0.016, t (70) =-0.0131, ns). Quantitative data revealed: more than half participants found the app “moderately satisfactory” (76%) and “moderately easy” to use (81%). However, comments raised showed discontentment with functionality of the app. Conclusions and recommendations: The study found the app to be effective in improving diet quality and physical activity at 6 weeks, but results were not sustained in the long run. However, the app was not effective in helping users achieve significant weight-loss compared to control. This research provides evidence that warrants the recommendation to use MH technology to address issues of healthy eating and physical activity in policy and practice. The app used in this study had major functionality concerns that require to be addressed opening it to use by the public