• Application of Behavior Change Techniques in a Personalized Nutrition Electronic Health Intervention Study: Protocol for the Web-Based Food4Me Randomized Controlled Trial

      Macready, A.L.; Fallaize, R.; Butler, L.T.; Ellis, J.A.; Kuznesof, S.; Frewer, L.J.; Celis-Morales, C.; Livingstone, K.M.; Araujo-Soares, V.; Fischer, A.R.H.; et al. (2018)
      In order to determine the efficacy of behavior change techniques (BCT) applied in dietary and physical activity intervention studies, it is first necessary to record and describe techniques which have been used during such interventions. Published frameworks used in dietary and smoking cessation interventions undergo continuous development and most are not adapted for online delivery. The Food4Me study (N=1607) provided the opportunity to use existing frameworks to describe standardized online techniques employed in a large-scale internet-based intervention to change dietary behaviour and physical activity.
    • Capturing health and eating status through a Nutritional Perception Screening Questionnaire (NPSQ9) in a randomised internet-based personalised nutrition intervention: the Food4Me study

      San-Cristobal, R.; Navas-Carretero, S.; Celis-Morales, C.; Livingstone, K.M.; Stewart-Knox, Barbara; Rankin, A.; Macready, A.L.; Fallaize, R.; O'Donovan, C.B.; Forster, H.; et al. (2017-12)
      Background: National guidelines emphasize healthy eating to promote wellbeing and prevention of non-communicable diseases. The perceived healthiness of food is determined by many factors affecting food intake. A positive perception of healthy eating has been shown to be associated with greater diet quality. Internet-based methodologies allow contact with large populations. Our present study aims to design and a short nutritional perception questionnaire, to be used as a screening tool for assessing nutritional status, and to predict an optimal level of personalisation in nutritional advice delivered via the Internet. Methods: Data from all participants who were screened and then enrolled into the Food4Me proof-of-principle study (n=2369) were used to determine the optimal items for inclusion in a novel screening tool, the Nutritional Perception Screening Questionnaire-9 (NPSQ9). Exploratory and confirmatory factor analyses were performed on anthropometric and biochemical data and on dietary indices acquired from participants who had completed the Food4Me dietary intervention (n=1153). Baseline and intervention data were analysed using linear regression and linear mixed regression, respectively. Results: A final model with 9 NPSQ items was validated against the dietary intervention data. NPSQ9 scores were inversely associated with BMI (β=-0.181, p<0.001) and waist circumference (Β=-0.155, p<0.001), and positively associated with total carotenoids (β=0.198, p<0.001), omega-3 fatty acid index (β=0.155, p<0.001), Healthy Eating Index (HEI) (β=0.299, p<0.001) and Mediterranean Diet Score (MDS) (β=0. 279, p<0.001). Findings from the longitudinal intervention study showed a greater reduction in BMI and improved dietary indices among participants with lower NPSQ9 scores. Conclusions: Healthy eating perceptions and dietary habits captured by the NPSQ9 score, based on 9 questionnaire items, were associated with reduced body weight and improved diet quality. Likewise, participants with a lower score achieved greater health improvements than those with higher scores, in response to personalised advice, suggesting that NPSQ9 may be used for early evaluation of nutritional status and to tailor nutritional advice.
    • The perceived impact of the National Health Service on personalised nutrition service delivery among the UK public

      Fallaize, R.; Macready, A.L.; Butler, L.T.; Ellis, J.A.; Berezowska, A.; Fischer, A.R.H.; Walsh, M.C.; Gallagher, C.; Stewart-Knox, Barbara; Kuznesof, S.; et al. (2015)
      Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the ‘framework approach’ described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.