Nutrition

Q&A: the WHEELS for DASH App

Recent research1 evaluated whether the novel WHEELS for DASH mobile app could improve users’ adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and whether users enjoyed using the app. After testing the app among 66 outpatients, the research team found that users improved their DASH eating patterns from week 1 to week 6 and from week 1 to week 8, and that users enjoyed using the app to track their eating behaviors.

The research team consisted of Susan Steigerwalt, MD; Scott Hummel, MD; Kristen DiFilippo, PhD candidate; Kenneth Jamerson, MD; and Margaret Scisney-Matlock, PhD, RN. They answered our questions about their study and the novel WHEELS for DASH app.

CARDIOLOGY CONSULTANT: Can you tell us more about the app and how it helped users stick to the DASH diet?

Researchers: Currently, the WHEELS for DASH mobile app supports the National Institutes of Health’s unique theory-driven and evidence-based “DASH Eating Plan” cognitive behavioral intervention (CBI) program. The mobile app provides twice-daily text notifications over 56 days to record dashboard momentary assessments of morning and evening CBI activities to (1) set one goal for adherence to one DASH food group, including fruit, vegetables, sodium, dairy, lean meats, fats, or grains; (2) respond to DASH diet cognitive representations brief survey questions of existing behavior, attitude, and skill; and (3) read individualized, tailored messages designed to fill DASH knowledge, attitude, and skill deficits. The evening text notification tracks DASH adherence patterns and other behavioral indices. The total time required to perform daily CBI activities is less than 8 minutes daily.

CARDIO CON: Your abstract mentions that this was a “novel” app. In what ways is this app novel?

Researchers: There are several novel attributes of the WHEELS for DASH mobile app. It is estimated that there are more than 100 DASH apps available—most are DASH food trackers, without users’ ratings or evaluation data available to determine usefulness. WHEELS for DASH is the only theory-driven DASH CBI technological solution tested and evaluated in a series of studies1,2 to determine the effect on blood pressure improvement and DASH adherence in outpatients with hypertension.

Second, the app’s CBI is derived from an original conceptual model anchored in self-regulation theory concepts created to describe a daily home-based program requiring less than 3 minutes for morning and 5 minutes for evening interactive activities.

Third, the CBI builds and maintains cognitive representations or memories to guide decisions for long-term dietary behavior change. 

CARDIO CON: What are your tips for cardiologists and other health care providers who may want to include this app in their hypertension treatment plans?

Researchers: Firstly, those who are considering integrating a technological tool in their hypertension treatment plan should consider the value proposition of that specific app for the usefulness to clinical workflow based on evaluative data gathered from health care providers, including registered dietitians’ recommendations. Our research team secured assessment and evaluation data of the virtual experience mobile app’s prototype for CBI fidelity components, including design, style, accuracy, and readability. The total level of agreement for fidelity components exceeded 85% for health care providers and registered dietitians to confirm readiness for further development and testing of the app, for hypertension management and blood pressure control in clinical practice. 

Another tip is to adopt a DASH technological solution that addresses the problem of health care providers’ reluctance to recommend DASH primarily due to lack of time to explain DASH and available educational resources, including theory-driven, effective technological vehicles or solutions.

CARDIO CON: What else should cardiologists or other health care providers know about your study?

Researchers: The app was built, tested, and evaluated at the Michigan Medicine Frankel Cardiovascular Center (FCVC) at the University of Michigan in Ann Arbor, and it is based on decades of funded multidisciplinary team research studies. 

WHEELS is the only evidence-based technological solution for DASH that was tested in the real world with outpatients. The standards used to develop WHEELS were critiqued and evaluated by UM registered dietitians, the American Dietetic Association (ADA), the ADA Evidence Analysis Library, the Cochrane Systematic Review of Best Dietary Intervention, and Science Direct.2

The unique feature is the efficacy of the WHEELS-I program’s CBI for reducing blood pressure in women from diverse ethnic backgrounds being treated for hypertension, enhancing DASH diet adherence, and shaping DASH diet cognitive representations. For the CBI group, paired T-test for systolic blood pressure at 1 and 3 months were significantly different (p=.000 and p=.004), -9.1 mm Hg (sd=14.66) and -8.22 mm Hg (sd=16.80) compared with 2.26 (sd=15.23) and -.40 (sd=13.14) for the control group. Women in the CBI group with baseline systolic blood pressure of more than140/90 mm Hg showed systolic blood pressure reductions of -13.09 mm Hg (sd=12.89) and -13.04 mm Hg (sd=13.04) at 1 and 3 months respectively.3

The app can help health care providers resolve the struggle to recommend the “DASH Eating Plan” at the point of care and connect to hypertension treatment guidelines.

References:

  1. Steigerwalt A, Hummel S, DiFillipo K, Scisney-Matlock M. A novel mobile app’s reliability, end user satisfaction, and changes in DASH diet eating patterns over 8 weeks. Paper presented at: American Heart Association Hypertension 2019 Scientific Sessions; September 5-8, 2019: New Orleans, LA. https://www.abstractsonline.com/pp8/#!/7943/presentation/639.
  2. Scisney-Matlock M, Glazewki L, McClerking C, Kachorek L. Development and evaluation of DASH diet tailored messages for hypertension treatment. Appl Nurs Res. 2006;19(2):78-87. https://doi.org/10.1016/j.apnr.2005.05.005.
  3. Scisney-Matlock M, Brough E, Daramola O, Jones M, Jones L, Holmes S. Therapeutic lifestyle changes to decrease unhealthy eating patterns and improve blood pressure in African Americans. In: Ferdinand KC, ed. Hypertension in high risk African Americans: Current concepts, evidence-based therapeutics and future considerations. 1st ed. Totowa, NJ: Humana Press; 2015:35-58.