A Smartphone App (mDASHNa-CC) to Support Healthy Diet and Hypertension Control for Chinese Canadian Seniors: Protocol for Design, Usability and Feasibility Testing.

Ping Zou,Yeqin Yang,Jennifer Stinson,Zhongqiu Lu,Cindy-Lee Dennis,Monica Parry

doi:10.2196/15545

Abstract

BackgroundThis proposed study aims to translate the Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians (DASHNa-CC), a classroom-based, antihypertensive, dietary educational intervention, to an innovative smartphone app (mDASHNa-CC). This study will enable Chinese Canadian seniors to access antihypertensive dietary interventions anytime, regardless of where they are. It is hypothesized that senior Chinese Canadians will be satisfied with their experiences using the mDASHNa-CC app and that the use of this app could lead to a decrease in their blood pressure and improvement in their health-related quality of life.ObjectiveThe goal of this study is to design and test the usability and feasibility of a smartphone-based dietary educational app to support a healthy diet and hypertension control for Chinese Canadian seniors.MethodsA mixed-method two-phase design will be used. The study will be conducted in a Chinese immigrant community in Toronto, Ontario, Canada. Chinese Canadian seniors, who are at least 65 years old, self-identified as Chinese, living in Canada, and with elevated blood pressure, will be recruited. In Phase I, we will design and test the usability of the app using a user-centered approach. In Phase II, we will test the feasibility of the app, including implementation (primary outcomes of accrual and attrition rates, technical issues, acceptability of the app, and adherence to the intervention) and preliminary effectiveness (secondary outcomes of systolic and diastolic blood pressure, weight, waist circumference, health-related quality of life, and health service utilization), using a pilot, two-group, randomized controlled trial with a sample size of 60 participants in a Chinese Canadian community.ResultsThe study is supported by the Startup Research Grant from Nipissing University, Canada. The research ethics application is under review by a university research ethics review board.ConclusionsThe study results will make several contributions to the existing literature, including illustrating the rigorous design and testing of smartphone app technology for hypertension self-management in the community, exploring an approach to incorporating traditional medicine into chronic illness management in minority communities and promoting equal access to current technology among minority immigrant senior groups.Trial RegistrationClinicaltrials.gov NCT03988894; https://clinicaltrials.gov/ct2/show/NCT03988894International Registered Report Identifier (IRRID)PRR1-10.2196/15545

Highlights

Rationale for the InterventionIn Canada, 1.3 million Chinese individuals comprise approximately 4.0% of Canada’s population and 21.2% of the country’s visible minorities [1]
Because the prevalence of hypertension increases with age, Chinese Canadian seniors are at especially high risk for hypertension and related mortality [4]
Effective dietary interventions are needed to assist with blood pressure control in Chinese Canadian seniors [11,12]

Summary

Methods

Adhering to a phased sequential approach to the development of complex technology-based interventions [54], the development of the mobile Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians (mDASHNa-CC) app will include app design, usability testing, and feasibility testing. Following the development of a fully functional smartphone-based prototype, usability testing (multiple iterative cycles) with semistructured audiotaped interviews will be conducted again with seven seniors in each cycle In this phase, a trained research assistant will first provide seniors with a brief (approximately 5 minutes) demonstration of the app on a smartphone using a standardized dietary assessment vignette. The dietary intake will be measured at baseline and eight weeks postrandomization by a one-to-one dietary interview using the validated Automated Multiple Pass Method [66] by a trained research assistant in the community center This approach was successfully tested in the DASHNa-CC pilot trial. Participation certificates will be provided to honor participants’ contributions to the study

Conclusions

Introduction

Discussion