Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial

Dori M Steinberg, Melissa C Kay, Laura P Svetkey, Sandy Askew, Jacob Christy, Jasmine Burroughs, Hira Ahmed, Gary G Bennett, Dori M Steinberg, Melissa C Kay, Laura P Svetkey, Sandy Askew, Jacob Christy, Jasmine Burroughs, Hira Ahmed, Gary G Bennett

Abstract

Background: Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed.

Objective: This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension.

Methods: We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure.

Results: The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: -2.8 mmHg, 95% CI -1.8 to 7.4; P=.23) and diastolic (mean difference: -3.6 mmHg, 95% CI -0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals.

Conclusions: A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH.

Trial registration: ClinicalTrials.gov NCT03215472; https://ichgcp.net/clinical-trials-registry/NCT03215472.

Keywords: DASH dietary pattern; digital health; hypertension; mHealth; nutrition; women’s health.

Conflict of interest statement

Conflicts of Interest: DMS reports serving on the clinical advisory board for Omada Health. GGB reports being a shareholder in Coeus Health and serving on a scientific advisory board for Nutrisystem. The remaining authors declare no conflicts of interest.

©Dori M Steinberg, Melissa C Kay, Laura P Svetkey, Sandy Askew, Jacob Christy, Jasmine Burroughs, Hira Ahmed, Gary G Bennett. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 07.12.2020.

Figures

Figure 1
Figure 1
Sample text message sent to participants in the DASH Cloud intervention. DASH: Dietary Approaches to Stop Hypertension.
Figure 2
Figure 2
Study flow and CONSORT diagram. CONSORT: Consolidated Standards of Reporting Trials. ASA24: Automated Self-Administered 24-hour recall tool.
Figure 3
Figure 3
Predicted mean days of diet tracking over time by study arm.

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