Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial
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Abstract
Background: Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective: This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods: We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results: The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions: A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration: ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472
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Digital health interventions significantly enhance dietary behaviors.
“and dietary behaviors (17, 18), thereby effectively supporting symptom control.”
From The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis (2025) · cites this paper as [18]
The Results (Change in DASH Adherence Across Arms; page unavailable) report significant increases in DASH adherence over three months in both groups of women with elevated blood pressure. The digital behavioral intervention did not improve adherence more than diet tracking alone (P=.97), so the paper does not establish the broad claim that digital health interventions significantly enhance dietary behaviors. (LLM, conf=0.88)
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Nishi, S. K., Kavanagh, M. E., Ramboanga, K., Ayoub-Charette, S., Modol, S., Dias, G. M., Kendall, C. W. C., Sievenpiper, J. L., & Chiavaroli, L. (2024) · eClinicalMedicine · doi:10.1016/j.eclinm.2024.102798 · Cited by 37 · see citing works
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- Authors
- Steinberg, D. M., Kay, M. C., Svetkey, L. P., Askew, S., Christy, J., Burroughs, J., Ahmed, H., & Bennett, G. G.
- Affiliations
- Duke University (US)
- Corresponding author
- Steinberg, Dori M
- ORCID
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2020-12-07
- Volume
- 8
- Issue
- 12
- Pages
- e17536
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC7752529
- OpenAlex
- W3085274984
- Cited by
- 41
- References
- 7
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 7 · 2023: 6 · 2022: 12 · 2021: 2
- FWCI
- 5.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD043446)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- DASH diet, hypertension, prehypertension, women, digital health interventions, dietary adherence, blood pressure reduction, feasibility, user engagement, personalized feedback, diet quality, lifestyle intervention, participant retention, participant satisfaction, participant dropout
- MeSH terms
- Blood Pressure, Diet, Feasibility Studies, Female, Humans, Hypertension, Male, Middle Aged, Text Messaging
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