Integrating mobile technology with routine dietetic practice: the case of myPace for weight management.

The field of Mobile health (mHealth), which includes mobile phone applications (apps), is growing rapidly and has the potential to transform healthcare by increasing its quality and efficiency. The present paper focuses particularly on mobile technology for body weight management, including mobile phone apps for weight loss and the available evidence on their effectiveness. Translation of behaviour change theory into weight management strategies, including integration in mobile technology is also discussed. Moreover, the paper presents and discusses the myPace platform as a case in point. There is little clinical evidence on the effectiveness of currently available mobile phone apps in enabling behaviour change and improving health-related outcomes, including sustained body weight loss. Moreover, it is unclear to what extent these apps have been developed in collaboration with health professionals, such as dietitians, and the extent to which apps draw on and operationalise behaviour change techniques has not been explored. Furthermore, presently weight management apps are not built for use as part of dietetic practice, or indeed healthcare more widely, where face-to-face engagement is fundamental for instituting the building blocks for sustained lifestyle change. myPace is an innovative mobile technology for weight management meant to be embedded into and to enhance dietetic practice. Developed out of systematic, iterative stages of engagement with dietitians and consumers, it is uniquely designed to complement and support the trusted health practitioner-patient relationship. Future mHealth technology would benefit if engagement with health professionals and/or targeted patient groups, and behaviour change theory stood as the basis for technology development. Particularly, integrating technology into routine health care practice, rather than replacing one with the other, could be the way forward.

Dietitian perceptions of low-calorie sweeteners.

BACKGROUND: Lowering energy (calorie) intake is essential in managing a healthy weight. One method of doing this is substituting sugar with low/no-calorie sweeteners. The safety of sweeteners has been debated, but little is known about how they are perceived by professionals responsible for weight management advice. We sought to explore dietitian perceptions of sweeteners and to identify the practical advice they provide about them. METHODS: We collected data in France, Germany, Hungary, Portugal and the United Kingdom. We used face-to-face interviews and a novel online tool designed to engage people with online content in a way that approximates everyday processes of making sense of information. RESULTS: We identified four approaches to sweeteners that dietitians took: (1) sweeteners should not be used, (2) they should be limited and used primarily as a transitional product, (3) sweetener use was decided by the client and (4) sweeteners should be recommended or at least allowed. Where dietitians are reticent to recommend sweeteners this is because they feel it is important for consumers to reduce their attachment to sweet tastes and of evidence linking the consumption of sweeteners to increased appetite. There is also uncertainty about the possible negative health effects of sweeteners. CONCLUSIONS: Dietitians' perceptions about sweeteners are uncertain, ambivalent and divergent, sometimes explicitly being linked to fears about adverse health effects. Clear and authoritative guidance is required on scientific evidence around sweeteners as well as the ways in which they can be used in dietetic practice.

myPace: an integrative health platform for supporting weight loss and maintenance behaviors.

Obesity is a major health concern caused by unhealthy eating behaviors. Digital weight loss interventions have adopted mobile technology primarily in order to support self-monitoring. However, many available apps are not designed as a part of dietetic practice; therefore, a distinct gap in the research exists relating to technology that supports the patient-practitioner relationship. This paper presents myPace, which is a complete weight loss and management system that is deployed via a smartphone and a PC. It connects dietitians and patients between face-to-face consultations and extends the relationship through patients' regular progress updates and dietitians' tailored and timely advice, for sustained behavior change. The prototype was developed from research into behavior change for weight loss, which furthermore was underpinned by theory and tenets of human support models, such as the supportive accountability framework. We report on an early-phase system design goals via a formative research process, which aimed to implement theoretical principles and match practical dietetic practice. To that end, only the clinical end user's perspective was sought through a coaching think-aloud protocol on the first iteration of the prototype and interviews with dietitians. Findings show that the system has many positive design features, but which require further development in order for the system to be fully acceptable within dietetic practice and motivate patient engagement.

Nonverbal communication in a Caribbean medical school: "Touch is a touchy issue".

BACKGROUND: The heath communication curriculum at the Trinidad campus of the University of the West Indies was developed out of practices advocated in large Western countries. Many students and tutors observed that the nonverbal skills advocated in these approaches did not fit the complex cultural dynamics of the Caribbean. PURPOSE: A study was developed to understand the problems Caribbean students faced with these nonverbal communication practices. METHODS: Thirty-six students representing different Caribbean territories were randomly selected from the two compulsory communication skills courses: Communication Skills for Health Personnel and Communication Skills for the Health Professions class list. These students participated in 4 focus group discussions (FGD). The FGD questions were formulated on the nonverbal skills advanced in the Calgary-Cambridge Guide to the doctor-patient interview. RESULTS: The findings supported the view that recommended nonverbal skills were in conflict with expected doctor-patient behavior in different Caribbean territories. Students felt that nonverbal communication needed to be treated with greater cultural sensitivity. CONCLUSIONS: These findings stimulated changes to the health communication program. this article identifies changes made to the communication skills program in response to cultural difference.

The need to teach non-verbal skills with multicultural sensitivity

The communication models that have been framed to guide medical practitioners through the determinative medical interview have primarily been conceived, evaluated and approved in the west. However, the student population at the Faculty of Medical Sciences at the University of the West Indies (UWI) in Trinidad and Tobago, where this material is concentrated, come from a number of Caribbean countries, as far north as the Bahamas and as far south as Trinidad. Consequently, the faculty at St Augustine is a very diverse campus. Interaction and fusion among Caribbean cultures have facilitated a great deal of intra-and inter-cultural diversity in the region. The non-verbal communication skills that theorists advocate, however, often cannot be easily applied to the Caribbean context. As a result, health communication educators encounter a number of problems in implementing so-called Western-based non-verbal communication skills in the classroom. This chapter is based on data collected at the Faculty of Medical Sciences at UWI. Thirty-six registered year 1 students from eight Caribbean countries were selected from the class list and asked to participate in focus group discussion between individual Caribbean territories and that put forward by the Calgary-Cambridge Guide to the doctor-patient interview. Here, the results of this study and its implications for health communication education in the region are interrogated. Ultimately, the chapter develops an approach from which regional health communication educators and medical practitioners can draw to achieve cultural competence in the classroom and in Caribbean medical practice.