Perceptions of self-monitoring dietary intake according to a plate-based approach: A qualitative study.

Dietary self-monitoring is a behaviour change technique used to help elicit and sustain dietary changes over time. Current dietary self-monitoring tools focus primarily on itemizing foods and counting calories, which can be complex, time-intensive, and dependent on health literacy. Further, there are no dietary self-monitoring tools that conform to the plate-based approach of the 2019 Canada Food Guide (CFG), wherein the recommended proportions of three food groups are visually represented on a plate without specifying daily servings or portion sizes. This paper explored the perceptions of end-users (i.e., general public) and Registered Dietitians of iCANPlateTM-a dietary self-monitoring mobile application resembling the CFG. Qualitative data were collected through virtual focus groups. Focus group questions were based on the Capability, Opportunity, Motivation-Behaviour (COM-B) theoretical framework to explore perceptions of using the CFG and currently available dietary self-monitoring tools. The prototype iCANPlateTM (version 0.1) was presented to gain feedback on perceived barriers and facilitators of its use. Focus group discussions were audio recorded and verbatim transcribed. Trained researchers used thematic analysis to code and analyze the transcripts independently. Seven focus groups were conducted with Registered Dietitians (n = 44) and nine focus groups with members from the general public (n = 52). During the focus groups, participants mainly discussed the capabilities and opportunities required to use the current iteration of iCANPlateTM. Participants liked the simplicity of the application and its capacity to foster self-awareness of dietary behaviours rather than weight control or calorie counting. However, concerns were raised regarding iCANPlateTM's potential to improve adherence to dietary self-monitoring due to specific characteristics (i.e., insufficient classifications, difficulty in conceptualizing proportions, and lack of inclusivity). Overall, participants liked the simplicity of iCANPlateTM and its ability to promote self-awareness of dietary intakes, primarily through visual representation of foods on a plate as opposed to reliance on numerical values or serving sizes, were benefits of using the app. Findings from this study will be used to further develop the app with the goal of increasing adherence to plate-based dietary approaches.

A Qualitative Evaluation of a Plate-Method Dietary Self-Monitoring Tool in a Sample of Adults Over 50.

Background: Self-monitoring is an important behavioral change technique to help users initiate and maintain dietary changes. Diet self-monitoring tools often involve the itemization of foods and recording of serving sizes. However, this traditional method of tracking does not conform to food guides using plate-based approach to nutrition education, such as the 2019 Canada's Food Guide (CFG). Objective: To explore the acceptability, facilitators and barriers of using a plate-based dietary self-monitoring tool based on the 2019 CFG (Plate Tool) compared with a traditional Food Journal (Food Journal). Methods: The 2 dietary self-monitoring tools were compared using a crossover study design over 2 wk. Adults over 50 (n = 47) from Montreal, Canada, were randomly assigned to use one tool over 3 d during 1 wk, then used the other tool the next week. Semistructured interviews (n = 45) were conducted after completing the second tool. A qualitative description of the interviews was conducted through an inductive determination of themes. Results: Facilitators to using the Plate Tool were its simplicity, quick completion time compared with the Food Journal and easiness to use, increased awareness of dietary habits and accountability, with participants expressing that it could help users make informed dietary changes aligning with the CFG. However, barriers to using the Plate Tool were its lack of precision, the participants' difficulty categorizing foods into the CFG categories and recording intake of foods not present on the CFG. Conclusions: The Plate Tool is an acceptable dietary self-monitoring tool for healthy adults over 50. Self-monitoring tools based on the plate method should take the barriers described in this study into account. Future studies should compare dietary self-monitoring methods to assess adherence and effectiveness at eliciting dietary behavior change.

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature.

BACKGROUND: Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines. METHODS: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme. RESULTS: Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT). CONCLUSIONS: Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.