Publication
Khan US, Mubashir M, Jawad T, Azam I, Siddiqui AR, Iqbal R. Development and validation of an electronic application (FoodEapp) to assess the dietary intake of adults in Karachi, Pakistan. Computer Methods and Programs in Biomedicine Update. 2023 Jan 1;4:100124
Abstract
Background
Under and over-nutrition-related health conditions are highly prevalent in Pakistan. Dietary data are required to understand the challenges of over and undernutrition in Pakistan.
Objective
The purpose of the study was to develop and validate a FoodEapp application (FoodEapp) for field staff with no formal education in nutrition (unskilled) to accurately collect 24-hour (24HR) dietary recall (DR) data to assess the dietary intake of adults in Karachi, Pakistan.
Method
We designed a novel FoodEapp application for unskilled data collectors to collect 24HR DR data. We validated the FoodEapp against the conventional 24HR DR method in rural and urban Karachi. We compared the mean intake of total energy (kcal), macronutrients, and micronutrients, reported through both methods using Pearson Correlation and Intraclass Correlation (ICC). We also used Bland Altman analysis to assess the agreement between the methods.
Results
We found a high correlation between the two methods for total energy (ρ = 0.88, p-value < 0.001), protein (g) (ρ = 0.81, p-value < 0.001), total lipids (g) (ρ = 0.74, p-value < 0.001), and carbohydrates (g) (ρ = 0.68, p-value < 0.001). Bland Altman's analysis showed good agreement in all the nutrients between the two methods.
Conclusions
FoodEapp has good validity and can be used to assess the dietary intake of the adult population in Karachi by non-nutritionists. This study may help overcome the limitation of dietary data collection and facilitate the researchers to conduct larger dietary surveys in Pakistan.
The publication used the Food Composition Database.
Naz, S., Haider, K. A., Jaffar, A., Khan, U., Azam, I., Siddiqui, A. R., & Iqbal, R.
(2023). Feasibility of a peer-supported, WhatsApp-assisted lifestyle modification
intervention for weight reduction among adults in an urban slum of Karachi,
Pakistan: a mixed-methods, single-group, pretest–post-test, quasi-experimental
study. BMJ open, 13(8), e070913
Abstract
Objectives
This pilot study assessed whether a peer- supported, WhatsApp- assisted lifestyle modification intervention for weight reduction is feasible to execute a definitive trial.
Design
A mixed-methods, single group, pretest and post- test, quasi- experimental study. Setting Azam Basti, an urban slum in Karachi, Pakistan. Participants Fifty participants (males and females aged 20–60) with a body mass index of >23 kg/m2, along with their nominated peers from the same family. Intervention Using motivational interviewing techniques, a trained nutritionist delivered the lifestyle modification intervention to the participants and peers for 3 days after the baseline assessment and then once monthly for 1 year. The intervention was delivered in groups using WhatsApp voice calls. The education sessions mainly focused on dietary modifications, physical activity advice and peer- support assignments to achieve a 5% wt loss from the participant’s initial body weight.
Outcomes
The feasibility measures included screening, recruitment, retention and monthly interview response rates. At 1 year, in- depth interviews (IDIs) with participants and peers were conducted to explore the facilitators, barriers, acceptability and experiences of the intervention. Changes in weight, calorie intake/day and calorie expenditure/day were also assessed.
Results
The recruitment and retention rates were 32% (n=50/156) and 78% (n=39/50), respectively, while the response rate for monthly interviews ranged between 66% (n=33) and 94% (n=47). The mean weight loss at 1 year was 2.2 kg, and the reduction in mean calorie intake was 386 kcal/day. There were no changes in the mean calorie expenditure. During the IDIs, participants and peers reported intervention via WhatsApp and peer support as convenient, flexible and supportive. Conclusions
The quantitative and qualitative findings of the current pilot study support the scale-up of this work with minor modifications to the screening method as well as close monitoring and motivational interviewing to improve adherence in terms of physical activity.