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Contents lists available at ScienceDirect

Patient Education and Counseling

journal homepage: www.elsevier.com/locate/pateducou

Discussion

Smartphone apps and the nutrition care process: Current perspectives

and future considerations
Juliana Chena,* , Luke Gemminga , Rhona Hanningb , Margaret Allman-Farinellia
a
School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
b
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada

A R T I C L E I N F O A B S T R A C T

Article history: Objective: To provide dietitians with practical guidance on incorporating smartphone applications (apps)
Received 9 September 2017 in the nutrition care process (NCP) to optimize patient education and counseling.
Received in revised form 2 November 2017 Methods: The current evidence-base for mobile health (mHealth) apps was searched using PubMed and
Accepted 16 November 2017
Google Scholar. Where and how apps could be implemented by dietitians across the four steps of the NCP
is discussed.
Keywords: Results: With functionality to automatically convert patient dietary records into nutrient components,
Apps
nutrition assessment can be streamlined using nutrition apps, allowing more time for dietitians to deliver
Dietetics
Counseling
education and nutrition counseling. Dietitians could prescribe apps to provide patients with education on
Education nutrition skills and in counseling for better adherence to behavior change. Improved patient-provider
mHealth communication is also made possible through the opportunity for real-time monitoring and evaluation
Nutrition care process of patient progress via apps. A practical framework termed the ‘Mobile Nutrition Care Process Grid’
provides dietitians with best-practice guidance on how to use apps.
Conclusions: Including apps into dietetic practice could enhance the efficiency and quality of nutrition
care and counseling delivered by dietitians.
Practice implications: Apps should be considered an adjunct to enable dietetic counseling and care, rather
than to replace the expertise, social support and accountability provided by dietitians.
© 2017 Elsevier B.V. All rights reserved.

1. Introduction Furthermore, having a standardized NCP framework facilitates

Nutrition care delivered by registered dietitians (RDs) is a
fundamental component of health promotion, and chronic disease
prevention and management [1], particularly given the high
prevalence of obesity, diabetes and other non-communicable
diseases [2–4]. In 2012, the Dietetic Workforce Demand Study Task
Force predicted only 75% of demand for RDs in the US would be met
in 2020 [5]. The study also identified technology as having
potential to transform how RDs deliver nutrition counseling and
personalized nutrition [6].
For the delivery of more consistent and effective quality
nutrition care by RDs, the Academy of Nutrition and Dietetics
(the Academy) recommends their nutrition care process (NCP)
[7,8]. The systematic method allows RDs to diagnose and
develop treatment plans for nutrition-related problems [7].
* Corresponding author at: The University of Sydney, Level 4 East, Charles Perkins
Centre (D17), John Hopkins Drive, Camperdown 2006, NSW Australia.
E-mail address: jche6526@uni.sydney.edu.au (J. Chen).
outcomes for research to evaluate the impact of nutrition care
on patient health outcomes. Subsequently, the efficacy of
nutrition care can be demonstrated, enabling advocacy for
the role of RDs in obesity and chronic disease treatment and
prevention [7,9]. Moreover, productivity and communication
between RDs and other members of the health care team have
improved through diagnosis-focused documentation of the NCP
[9]. There is now the opportunity for advocating the NCP
further with technology.
The public market for and acceptance of mobile health
(mHealth) technologies, such as smartphone applications (apps)
has experienced dramatic growth, with over 259,000 mHealth
apps available [10]. Fifty-eight percent of US smartphone owners
have downloaded a health-related app [11], with fitness and
nutrition apps most frequently downloaded [12]. The proliferation
and low-cost of many nutrition apps may appear a threat to RDs
services. However, if implemented appropriately, apps could
support dietetic practice by increasing accuracy, efficiency and
quality of clinical decision-making when applying the NCP [13], as
well as improving patient access to point-of-care services and

https://doi.org/10.1016/j.pec.2017.11.011
0738-3991/© 2017 Elsevier B.V. All rights reserved.

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considerations, Patient Educ Couns (2017), https://doi.org/10.1016/j.pec.2017.11.011
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patient-provider communication, to ultimately improve patient
outcomes [14].
Recent reports indicate the dietetic profession has adopted
health apps into their practice. Eighty-three percent of US RDs
were found to recommend apps [15]. In Canada, 57% of dietitians
used apps in practice, and a three country study of Australian, New
Zealand and British dietitians found 62% used apps in patient care
and 84% recommended apps [16].
Despite the rates of app adoption by dietitians, the profession
has expressed their desire for more education and training around
incorporating apps into dietetic practice, especially private
practice [15,16]. To support app use among RDs, the Academy
has undertaken science-based reviews of nutrition apps, which are
included in their Food & Nutrition magazine [17]. However, there
has been no systematic process proposed of how to incorporate
apps into the NCP. Therefore, the purpose of this paper was first to
identify the areas in which an RD could practically implement
health apps across the four steps of the NCP (i.e. nutrition
assessment, nutrition diagnosis, nutrition intervention and nutri-
tion monitoring and evaluation). Secondly, the medical nutrition
literature (PubMed) and more general sources (Google Scholar)
were searched for research on implementation of health apps to
support weight loss, diabetes, healthy lifestyles, nutrition care, and
dietetic practice. Finally, a framework to guide the use of apps in
the NCP was constructed.
2. Nutrition assessment
During patient assessment, RDs will obtain, verify and interpret
anthropometric, biochemical, medical, social and client history, as
well as dietary information [8]. RDs usually conduct a diet history
to estimate nutritional adequacy and meal patterns but sometimes
ask patients to keep a diet record in advance of their consultation.
However, paper-based dietary records are burdensome for patients
and labor-intensive for RDs to analyze, thereby reducing counsel-
ing time available [18].
Ninety-three percent of US adults use their smartphone while
eating [19]. Apps provide a convenient means to record data in
near real-time during eating occasions and have demonstrated
greater acceptability than paper-based food diaries [20–22].
Dietitians and health care providers also show acceptance towards
technology-assisted dietary assessment [16,23]. Most nutrition
apps convert the food intakes into nutrients and provide valid
estimates of energy and nutrient intake comparable to traditional
dietary assessments [24–26]. An evaluation of variance across 23
commercial weight loss apps revealed that 17 of 23 apps assessed
were within 100 kcal of weighed food records [27].
Some commercial apps also include image logs to complement
the digital dietary record and assist with prompting memory when
reviewing records or by dietitians for qualitative assessment
[27,28]. Sole image-based dietary record apps show promise in
lowering the burden of logging, though challenges remain for
automated computer vision approaches to reliably assess the vast
array of foods [29].
Collection of anthropometric measurements and monitoring
could also be enhanced. Apps and wireless scales provide a popular
and simple method to assess, monitor and visualize weight history
[27]. The Academy’s NutriCare Tools app contains a compilation of
evidence-based tools, including calculators that assess energy and
fluid requirements and a range of anthropometric tools [30].
Fitness and exercise wearables, such as Fitbit or smart watches, can
also support the passive assessment of physical activity, including
valid estimates of step counts and energy expenditure [31,32].
Apps for diabetes management enable patients to log blood
glucose levels, track insulin injections and oral medication and
record exercise, carbohydrate and other dietary intake [33]. These
Please cite this article in press as: J. Chen, et al., Smartphone apps and the nutrition care process: Current perspectives and future
considerations, Patient Educ Couns (2017), https://doi.org/10.1016/j.pec.2017.11.011
‘all-in-one’ apps are convenient for patients, and allow RDs to
pinpoint certain foods, carbohydrate intake patterns or physical
activity sessions influencing patients’ blood glucose. Some
diabetes apps also allow patients to synchronize blood glucose
measurements from glucometers for simplified recording and
visualization of trends [34–36]. Certain diabetes apps have been
approved by the US Food and Drug Administration [33,37].
3. Nutrition diagnosis
From data gathered in nutrition assessment, RDs can identify
the etiology, signs and symptoms of nutrition problems, which can
then be targeted through a treatment or nutrition intervention [8].
With many complex terminology references in this step, the
former IDNT app, now integrated into the Kalix software [38,39], is a
useful tool for guiding RDs on the selection of relevant and
appropriate nutrition diagnoses. Nutrition diagnostic domains
most likely to be established by health apps include the intake
domain for energy, nutrients and fluids; clinical domain diagnoses,
such as weight loss or weight gain and behavioral-environmental
aspects, such as knowledge and beliefs and physical activity [8].
Identifying the etiology of a nutrition problem is necessary for
subsequent implementation of nutrition interventions. Etiologies
related to the behavior category of the Nutrition Diagnosis Etiology
matrix (e.g. disordered eating pattern, excessive or inadequate
energy intake, excessive physical activity) [8] are readily identified
by health apps. With continued recording, dietary patterns and
anomalies can be detected, albeit dependent on patient input of
the data. Therefore, examining patient-generated health data
(PGHD) via app records may also allow RDs to uncover additional
information about other etiological categories, such as beliefs-
attitudes, cultural or knowledge, that may be contributing to the
nutrition problem.
4. Nutrition intervention
To address the etiology or signs and symptoms of the nutrition
diagnosis, RDs plan individualized interventions and provide
nutrition education and counseling [8]. Dietitian-specific tools,
such as NutriGuides, an app developed by the Academy, contains an
accessible compilation of the Evidence Analysis Library to help RDs
determine best-practice treatment [40].
Emerging evidence provides some support for using apps in
lifestyle change [41,42], and weight [42,43] and chronic disease
management [44–46]. However, apps appear to be more effective
when complemented with counseling sessions, education or other
mHealth technologies (e.g. text messaging) in multi-component
interventions rather than with standalone use [41,47,48]. The
importance of dietitians in providing coaching [48,49] is affirmed
by the lack of success when nurses or physicians provided such
care [50–52]. It should be noted, most effective interventions
involved younger adults, who typically engage with apps more
successfully than older participants. Thus, RDs must assess the
appropriateness of prescribing apps in nutrition interventions
based on individual patient demographics and motivations.
Nutrition education is a NCP intervention strategy [8], and using
apps to deliver information is likely to be acceptable to patients,
given 63% of US smartphone users access information about health
conditions via smartphones [53]. Calorie or nutrient information
provided by apps are reported to be a useful resource in patient
nutrition care [16]. Educational information on diabetes, including
managing blood glucose and diabetes-related treatments are also
accessible in some diabetes apps [33,54]. However, there is
opportunity for more personalized patient education, particularly
apps centered around dietary and clinical guidelines [27,33,54–56].
Nutricare Tools app provides education on reading food labels [30].
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Fooducate provides interpretations of nutrients and ingredients of
food labels from scanned product barcodes [57,58], and ShopWell
scores foods based on individual dietary preferences, with content
that has been reviewed and developed by RDs [59,60]. FoodSwitch
is a commercial-research partnership app that utilizes a traffic
light system for identifying healthier packaged foods [61].
Researchers have also developed the MyNutriCart app based on
the Dietary Guidelines for Americans [62].
An important strategy RDs use to enable behavior change is
setting mutually acceptable and tailored goals with patients.
Generic goal setting is a common feature in apps [27,33,63–69].
However, personalized goal setting is often only available in
premium subscription versions of commercial apps. Dietitians of
Canada developed eaTracker, an app allowing users to choose from
87 ‘ready-made’ SMART goals, covering 13 different categories, or
to write their own goals [70,71]. Data mining of health app data
revealed greater odds of weight loss success with the more
customization features users implemented, such as customized
goals, recipes, foods as some examples [72].
Regular and frequent self-monitoring is a foundational compo-
nent of weight loss [73] and improved glycemic control in diabetes
management [74]. Adherence to self-monitoring is superior with
apps compared to traditional pen and paper-based records
[22,43,55,75,76], making apps a good choice for increasing patient
compliance with self-monitoring and achieving positive weight
and dietary outcomes [72,76–79]. Self-monitoring increases
patient awareness of behaviors, giving them confidence to self-
manage their health, for example adjusting insulin based on self-
monitored blood glucose readings [46].
When RDs are considering what apps to recommend for self-
monitoring, it has been demonstrated that weight loss success is
Fig. 1. A hypothetical patient case outlining how smartphone applications (apps) could be implemented into each step of the nutrition care process to support patient weight
management.
Please cite this article in press as: J. Chen, et al., Smartphone apps and the nutrition care process: Current perspectives and future
considerations, Patient Educ Couns (2017), https://doi.org/10.1016/j.pec.2017.11.011
3
predicted by consistent dietary monitoring through an app,
irrespective of the actual app used to track diet [75]. Long-term
sustained use of apps for dietary self-monitoring is challenging to
maintain, and adherence to app use rapidly declines over time
[22,50,80]. Patient engagement with apps can be increased
through human support and accountability [81]. Retention rates
for mHealth apps are higher when health care professionals
prescribe mHealth apps to patients rather than making general
recommendations [12]. Thus, RDs should define a realistic
frequency and pattern of tracking tailored to patients’ individual
capacities for self-monitoring and lifestyles when they prescribe
apps. Self-monitoring consistently over consecutive days may be
unnecessary, with evidence highlighting that long-term intermit-
tent self-monitoring over 6 months was more successful and
associated with greater weight loss compared to short-term self-
monitoring [77]. Where patients are less compliant with self-
monitoring, encouraging frequent logging of only specific meal
occasions, such as dinner, can assist in the maintenance of weight
loss [77]. Logging physical activity for sustained periods using
wearables presents fewer challenges due to their passive nature
and ability to sync automatically with apps.
Finally, the time and frequency of conventional nutrition care
are generally limited to face-to-face encounters at fortnightly or
monthly consultations. While immediately after the consultation,
patients may be motivated to implement discussed strategies,
motivation and adherence to dietary plans between consultations
may decline. Stein has previously discussed a range of apps that
enable remote nutrition counseling and could enhance dietetic
practice models [82]. The ability of apps to allow remote near real-
time monitoring of weight, nutrition and physical activity can
increase the frequency of patient-dietitian interactions, and allow
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monitoring and adjustment to the nutrition intervention to occur
in a timelier manner, even between consultations [82].
5. Nutrition monitoring and evaluation
Given the ultimate aim of the NCP is to help patients better
meet their nutrition and health goals [7], monitoring, measuring
and evaluating the effectiveness and overall impact of medical
nutrition therapy intervention is essential [8]. These processes
allow RDs to judge when to continue, modify or cease inter-
ventions.
If patients are compliant with self-monitoring via apps,
patterns in patient’s dietary intake may be revealed and factors
assisting or hindering goal attainment identified. Examples include
frequency of meals or snacking, eating out, physical inactivity,
sourcing of foods or even highlighting emotional eating episodes
for eating disorder patients [83], which would allow RDs to discuss
tailored strategies with patients to overcome barriers and lapses.
The literature affirms that patient self-management and behav-
ioral regulation is more effective when self-monitoring is
combined with other components of control theory, such as the
provision of feedback on performance and reviewing of goals
[84,85]. To promote patient accountability after app prescription,
review of app records of PGHD should be routine in nutrition care.
In current practice, reviewing of app data as part of every follow-up
consultation is infrequent among dietitians [16]. More commonly
patient progress made with apps is only reviewed in some
consultations via patient reporting without direct reference to the
app data [16].
Apps with data sharing functionalities that innately integrate
into dietitian-designed health record platforms (e.g. Healthie, Easy
Diet Diary Connect and MyPace) [86–89] present opportunities to
increase the convenience of accessing and reviewing app records
[90]. In turn, the quality of patient-provider communication and
degree of support between consultations from remote nutrition
care is enhanced through the greater connectivity of apps
[33,82,90]. Many diabetes apps have capabilities to export data
via email, unlike most weight loss apps [27,36,65]. Through such
platforms, timely feedback from an RD at the point of patient
lapses occurring can increase patient autonomy and empower
them to respond to triggers and self-regulate their own health
behaviors [88].
While it may not be feasible or financially viable for RDs to
monitor all their patients in real-time to provide instant feedback,
adjustments in work task schedules or care delivery models can
allow more timely responses [91]. Advances in software and data
mining will assist this in the future [92,93]. Health apps often
include standardized criteria for weight, glycemic control, or
recommended physical activity, calorie and nutrient intake making
automatic comparisons possible. Alerts could be integrated into
the platforms for review on a daily basis [90]. However, the validity
and country-specificity of the reference standards in algorithms
should be ensured [27,90]. Provision of RD fees that allow
monitoring of PGHD from apps would facilitate the suggested
model of care [82].
A hypothetical case study is presented in Fig. 1, with sample
practice data outlining how apps could be included across the NCP.

Energy and nutrient intake informaƟon

Physical acƟvity NI-5.8.2 NB-2.1 Physical acƟvity

FH-7.3 NI-1.1 NI-5.2
informaƟon NI-5.8.3 NB-2.2 informaƟon
NI-1.2 NI-5.3
NI-5.8.4
FH-1.1.1 NI-1.3 NI-5.4
FH-1.5.3 NI-5.8.5
FH-1.2.1 NI-1.4 NI-5.6.1
Anthropometric FH-1.2.2
FH-1.5.4
NI-2.1 NI-5.6.2
NI-5.8.6
AD-1.1 FH-1.6.1 NI-5.9.1
measures FH-1.4.1 NI-2.2 NI-5.6.3 NC-3.1
FH-1.6.2 NI-5.9.2
FH-1.5.1
FH-5.3
NI-2.9 NI-5.7.1
NI-5.10.1 NC-3.2 Anthropometric
FH-1.5.2 NI-3.1 NI-5.7.2 NC-3.3 measures
Daily NI-3.2 NI-5.7.3
NI-5.10.2
NI-5.11.1 NC-3.4
blood glucose BD-1.5 NI-5.1 NI-5.8.1
NI-5.11.2
measures

CS-1.1
NB-1.4 Behavioural
CS-2.1
CS-2.2
NutriƟon NutriƟon NB-1.5
NB-1.6
knowledge and
Comparison to CS-2.3 Assessment Diagnosis NB-1.7 beliefs
CS-2.4
standards CS-3.1
CS-4.1 mNCP
CS-4.2 E-1
NutriƟon educaƟon
CS-5.1 NutriƟon NutriƟon
E-2

Monitoring & IntervenƟon

PaƟent-provider C-1
communicaƟon
FH-5.5 EvaluaƟon C-2
Social support

PaƟent compliance to C-1 C-1 PaƟent self-

FH-5.1 FH-5.1
recommendaƟons C-2 C-2 monitoring

Remote
monitoring of Feedback on performance Goal-seƫng
paƟent progress
Key:
NutriƟon Care Process Terminology terms
NutriƟon Care Process elements that are supported by smartphone applicaƟons

Fig. 2. The mobile Nutrition Care Process (mNCP) grid to support Medical Nutrition Therapy.

Please cite this article in press as: J. Chen, et al., Smartphone apps and the nutrition care process: Current perspectives and future
considerations, Patient Educ Couns (2017), https://doi.org/10.1016/j.pec.2017.11.011
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6. Mobile nutrition care process grid
Fig. 2 outlines a framework termed the mobile Nutrition Care
Process (mNCP) grid that has been developed to support RDs in their
use of apps throughout the steps of the NCP. Under each of these
steps, the uses of apps have been matched to Nutrition Care Process
terminology. Features related to the uses of apps and their
contributions to nutrition care are outlined in Table 1.
7. The future of apps and wearables for dietetic practice
As competition increases to meet consumer expectations for
high quality, convenient and accessible health services, and
simultaneously ensure that health care costs are minimized, apps
and other mHealth technologies present an opportunity to support
dietitians. Dietitians would like continuing education and training
from their professional associations to improve their capacity and
motivations for using apps, such as understanding how apps could
be used as supportive tools that add value rather than threaten
their practice [6,16]. Incorporating apps into the NCP could permit
the dietitian to devote more practice time to nutrition behavioral
counseling.
RDs have reported that video conference apps and smartphones
are among the technologies they were currently or expecting to use
for telehealth within the next five years [94]. Nutrition and dietetic
services delivered via telehealth in the US is reimbursable by third-
party payers, but not in most other countries [94]. However, RDs
still identified barriers to existing payer coverage. Revisions to
reimbursement schemes to accommodate incorporation of apps
into telehealth and remote nutrition care may be necessary to
provide monetary incentive for private practice dietitians to
review patient app records and provide feedback within and
between patient consultations.
As in all aspects of dietetic practice, RDs need to apply critical
thinking skills to determine the suitability of prescribing or using
technology with their patients in the NCP. Considerations should
be given to patient familiarity with technology, ability to adopt
technology, motivation and readiness to change and their ability to
sustain use and interest in these technologies [95]. Generally,
however, greater engagement and willingness to adopt mHealth

Table 1
The functions of smartphone applications (apps) that contribute to the Nutrition Care Process (NCP).

NCP element App functions Contribution to NCP

Energy or nutrient Automatic quantitative calculations of energy and macro- (including Electronic food record. Reduces the time required to conduct diet history
intake alcohol) and micronutrient intake values based on foods inputted. and with basic dietary information gathered, additional probing of
information dietary habits could be conducted.
Physical activity Automatic tracking of physical activity intensity and duration when Passive collection of physical activity data can provide more objective
information linked to wearable devices and apps. Steps can also be tracked. Manual evidence about a patient’s physical activity.
logging of activities in some apps.
Anthropometric Record weight measures through manual input or via Bluetooth scales. Track weight against goals.
measures
Anthropometry calculators (e.g. BMI calculators). Convenient access to calculators used in anthropometry.
Data in graphical forms. Easy visualization of progress through weight graphs.
Blood glucose Record blood glucose, HbA1C. Allows patients to track blood glucose and identify food and lifestyle
measures triggers for elevated blood glucose levels.
Connectivity to glucometer. Additional source of data for RD.
Comparison to Automatic comparison of intake to Dietary Reference Intakes values for Time-saving and removes manual analysis by RD.
standards energy, macro- and micronutrients.
Behavioral Regular app records of dietary intake. Detecting deficits in self-monitoring. Providing evidence to support
knowledge and limited adherence to nutrition-related recommendations or undesirable
beliefs food choices as well as disordered eating.
Nutrition Information about foods available for therapeutic diets, calorie and Increasing knowledge and skills about food choices for therapeutic diets,
education nutrient content of foods. food choices and energy balance.
Nutrition information to enable healthy choices in the supermarket.
Social support Messaging and coaching functions from within the app. Enabling the delivery of motivational support from a dietitian between
from dietitian consultations.
Newsfeeds. Enhance patient confidence with making changes to behavior from
collaborative relationship.
Patient self- Tracking of diet, weight and other health behaviours e.g. physical activity, Increasing patient awareness of behavior and outcomes. Empowering
monitoring blood glucose. patients to self-regulate behaviors. Enhanced compliance to self-
monitoring when using an app. Pinpointing and presenting fine-grained
real-time data.
Goal-setting Setting goals for diet, weight, physical activity, blood glucose. Tracking of progress against goals promotes dietary behavior change.
Goals negotiated in the consultation can be entered into the app for Patients are able to see the goals negotiated with their dietitian to enable
patients to track. greater awareness of what to achieve before the next consultation.
Graphs/visuals to show progress against goals. Building confidence through stepwise improvement and achievable
goals.
Feedback on Immediate feedback on data logged. Algorithms can allow for Near real-time feedback compared with standards allows patients to
performance personalised feedback for individuals. adjust their behaviors as they occur, or guiding patients towards better
food choices, rather than waiting for the next consultation before they are
addressed.
Remote Remote monitoring of progress and performance between consultations. Adjustments to nutrition intervention occur in timely manner.
monitoring of
patient
progress
Patient App records provide information to determine patient adherence to Opportunity to discuss episodes of non-compliance and lapses and to
compliance to dietary prescriptions. address barriers and new enabling strategies with RD. Increases
recommendations accountability of patients.
Patient-provider Exporting of patient-generated health data collected by apps via email or Enhancing patient-provider communication can increase patient
communication into a platform for dietitians to view. satisfaction and greater perceived value of dietetic services.

Please cite this article in press as: J. Chen, et al., Smartphone apps and the nutrition care process: Current perspectives and future
considerations, Patient Educ Couns (2017), https://doi.org/10.1016/j.pec.2017.11.011
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technologies exists among individuals identifying with the
‘quantified self’ movement and those who want to take a more
active role in self-managing their own health care [96,97], and
younger adults where technology is a fundamental part of their life
[53]. Therefore, RDs should recommend a medium that is most
appropriate to patient characteristics whether across the entire
NCP or at certain steps (e.g. nutrition interventions).
8. Conclusion
Apps are currently under-utilized by dietitians in the NCP, yet
they have the potential to make medical nutrition therapy more
efficient, especially in the private practice setting. Conversion of
the patient input of food consumed into nutrients by nutrition apps
will streamline nutrition assessment and allow more time for
education and nutrition counseling. RDs could consider prescrib-
ing apps in combination with their nutrition counseling, to
increase adherence to self-monitoring of patient-centered goals.
Apps could also be used to monitor and evaluate patient
compliance with a nutrition plan through the real-time data
collected and enable bidirectional information exchange.
Practice implications
An app is only as good as the quality of data entry and its
algorithms, but combined with the critical-thinking expertise,
social support and accountability of an RD, they may support
individualized patient-centered nutrition care. Dietitians have a
leading role in directing the design of apps to better support their
practice and clients. Lastly, funding mechanisms for review of
patient data outside face-to-face appointments will be needed for
RDs and their patients to achieve the full benefits technology can
offer.
Author’s contributions
JC and MAF contributed to the conception and design of the
study. JC conducted the research and drafted the first version of the
manuscript. LG, RH and MAF contributed to writing and editing the
manuscript. All authors read and approved the final manuscript
submitted.
Funding and conflict of interest disclosures
JC is a PhD student at The University of Sydney, funded by the
funded by the Australian Government Research Training Program
scholarship, but declares no personal or financial conflicts of
interest. The Australian Government Research Council had no
involvement in this research. LG and RH declare no conflicts of
interest. MAF has developed food and nutrition based apps for
research purposes.
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