Investigating the potential of using mHealth apps to support DASH diet self-management among individuals with high blood pressure in Saudi Arabia

Abstract

Background: Hypertension is a significant risk factor for cardiovascular disease and stroke, affecting 1.28 billion adults worldwide. Saudi Arabia has a high prevalence of hypertension, with 48.2% of adults aged 40 to 64 living with high blood pressure (BP) in 2018. Lifestyle management is crucial in addressing this issue. Strategies for preventing and controlling hypertension include maintaining a healthy body weight, increasing physical activity levels, and adopting the Dietary Approaches to Stop Hypertension (DASH) diet as the front-line strategy. Effective dietary self-management can enhance adherence to the DASH diet and help control BP. In this context, mobile health (mHealth) apps are increasingly considered valuable resources for managing individuals’ diets. Smartphone apps may provide new opportunities to improve nutrition interventions and change behaviour. Nevertheless, despite these advantages, patients and health-care professionals can face difficulties in identifying and selecting the most suitable apps. Further research is needed to determine whether mHealth apps can support DASH diet self-management and improve adherence among individuals with high BP in Saudi Arabia. Aims: The overall aim of this thesis is to investigate the potential of using mHealth apps to support DASH diet self-management among individuals with high BP in Saudi Arabia.

Methods: Four studies were conducted in two phases. Phase one aimed to identify the most suitable DASH diet self-management apps. An exploratory approach was used to gather information on relevant apps, including their effectiveness, theoretical basis, quality, safety, security, characteristics, and functions. This phase consisted of two studies: 1) a systematic review of existing literature and 2) an app store review. Phase two aimed to select the most suitable DASH diet app for the Saudi Arabian context and to evaluate its feasibility and acceptability within this context. This exploratory phase involved two studies: a qualitative study and a feasibility study. The qualitative study sought to gain insights into the experiences and perspectives of individuals with high BP and healthcare professionals who have used the DASH diet self-management apps identified in phase one as high-quality, secure, and potentially effective (Noom and DASH To Ten). This information was crucial in selecting the most appropriate app for the Saudi context. The feasibility study evaluated the feasibility and acceptability of using the Noom app to support DASH diet self-management among individuals with high BP in Saudi Arabia.

Results: The first phase identified two high-quality, secure, and potentially effective DASH diet apps: DASH To TEN and Noom. In the second phase, the participants in the qualitative study selected the Noom app as the most suitable for the Saudi context. While during the feasibility study, the participants found the Noom app to be feasible and acceptable, they also suggested improvements for greater accessibility to the Saudi population, including translating it into Arabic and simplifying the food logging process.

Conclusion: The contributions of this thesis are significant in addressing a crucial gap in current research: the need for more studies exploring the use of smartphone apps to enhance adherence to the DASH diet to control BP. The research employed a systematic staged approach to identify and select commercial dietary smartphone applications, enabling researchers to make well-informed decisions when selecting dietary apps. This approach provided a solid basis for developing a high-quality RCT of a widely available DASH diet app since this research carefully identified and selected a commercial DASH diet app and evaluated its feasibility, usability, and acceptability among individuals with high BP in Saudi Arabia. However, conducting an RCT in Saudi Arabia may face challenges if the app is not adapted to address participants' recommendations, particularly concerning the need to enhance its educational content to better align with the needs of Saudi users. In addition, dietitians can leverage these findings to recommend two high-quality, potentially effective, and secure apps to their patients, aiding in DASH diet self-management. This research also offers critical insights into the interactive features of these dietary apps, informed by feedback from both patients and health professionals. These insights are instrumental for researchers and developers aiming to design more effective and user-friendly dietary applications. This research’s exploration of the feasibility and acceptability of commercial dietary apps among Saudis can inform further studies in the mHealth field.