Creating a Smartphone Application for Image-Assisted Dietary Assessment among Older Adults with Type 2 Diabetes

Abstract

In the United States, the population of those aged 65 or over numbered 44.7 million in 2013 and is anticipated to reach approximately 74 million people by 2030. More than one in four people in the United States aged 65 years and older have diabetes. For diabetes care, medical nutrition therapy (MNT) is recommended as a clinically effective intervention. For personalized MNT, it is essential for dietitians to assess the nutritional status of patients with a variety of dietary data (i.e., meal patterns, food choices, and overall dietary balance). However, it is difficult to obtain accurate information because traditional dietary assessment methods (e.g., 24-hour dietary recall (24HR), food records) are based on self-reported data. In particular, those methods might be inappropriate for older adults because they have special considerations with diminished functional statuses (i.e., diminished vision and memory loss). To address this problem, previous researchers have developed and validated dietary assessment methods using images of food items for improving the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability and feasibility of image-assisted dietary assessment methods for older adults with diabetes and their satisfaction with the methods. To my knowledge, no studies evaluated the image-assisted dietary assessment methods with both health providers (i.e., dietitians) and patients (i.e., older adults with diabetes), though both are essential stakeholders in the dietary assessment process. Further, little is known about the usability and feasibility of smartphone applications for an image-assisted dietary assessment, though a smartphone is the device that can perform multiple tasks (i.e., capturing, viewing, and transmitting images) required for an image-assisted dietary assessment. Filling these gaps may reduce errors in self-reporting by older adults with diabetes and result in more accurate dietary assessments. The overall aim of this research is to assess whether a smartphone application can improve the accuracy of traditional dietary assessment methods among older adults with type 2 diabetes. To achieve the overall aim, I created a food record app for dietary assessments (FRADA), a smartphone application for capturing, viewing, and transmitting images of food and beverages, and I evaluated the usability and feasibility of FRADA and the satisfaction of older adults with diabetes with the application. Further, I evaluated the satisfaction of dietitians with an image-assisted, 24-hour dietary recall interview. The findings of this research support the evidence that image-assisted dietary assessments using FRADA could be potentially used to improve the accuracy of a traditional dietary assessment method by reducing errors in self-reporting. Also, this study reveals design opportunities to facilitate communications be- tween older adults and dietitians for better dietary assessments. To my knowledge, this is the first attempt to evaluate a smartphone application with both older adults and dietitians through a lab-based and deployment study based on 24-hour dietary recall interviews. The aims of this study are: - Aim 1: To create a smartphone application for image-assisted dietary assessments and determine the usability of the application for older adults with diabetes. - Aim 2: To determine the feasibility of the smartphone application in older adults with diabetes for image-assisted dietary assessments. - Aim 3: To determine the satisfaction of older adults with diabetes with the smartphone application for image-assisted dietary assessments and determine the satisfaction of dietitians with image-assisted 24-hour dietary recall interviews.