Use of digital food records in clinical settings - lessons in translation from a randomised controlled trial

Abstract

Background Digital food records provide an efficient way to collect and assess dietary information remotely; however, there is limited research into factors which may impact their translation into clinical settings. Methods The study aimed to examine factors that may impact integration of a digital food record (mobile food diary app, electronically linked to a nutrition analysis software program) into clinical dietetic practice. This was achieved by assessing 1) the source and rate of data errors received (participant data entry or software) 2) the impact of dietitian-adjusted data on dietary variables; and 3) acceptance of use in a complex chronic disease cohort. Study participants were adults from specialist liver and kidney disease clinics who were enrolled in a randomised controlled feasibility trial. Participants recorded their dietary intake for three days using a mobile food diary app (Research Food diary, Xyris Software Pty Ltd) and this was analysed via desktop electronic nutrition analysis software (FoodWorks, Xyris Software Pty Ltd). Each participant’s digital food record was verified by a dietitian and errors were corrected. Dietary variables from digital food records before (participant-unadjusted data) and after (dietitian-adjusted data) were compared by non-parametric Wilcoxon signed ranks test, Bland Altman and Passing Balok analysis. Participant acceptance of using the mobile food diary app was assessed via online surveys and interviews. Results Errors appeared in 93% of the records. Dietitian-adjusted median data were higher for all macronutrients, five core food groups and other variables including energy and fibre intake than participant-unadjusted data (p < 0.05, median changes between 10–65%) of 59 participant records(median age 51 years, interquartile range 38–58). There was poor agreement between participant-unadjusted and dietitian-adjusted data for dietary variables including saturated fat, vegetables and added sugar intake. Sixty-four percent of participants who completed the survey (n = 32/50) found the app easy to use, while interviews with 29 participants provided insights into several technical challenges experienced. Conclusion Significant barriers to integrating digital food records into clinical practice exist related to errors that require dietitian adjustment to improve data quality for clinical decision making. Overall, there was variable acceptance towards the mobile food diary app. Trial registration: Australia and New Zealand Trials Registry ACTRN12620001282976. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337