NHD-EXTRA: RESEARCH & RESOURCES
SMARTPHONE APPLICATIONS: ARE THEY A HELP OR A HINDRANCE? Dr Carina Venter PhD, RD Assistant Professor, University of Colorado Denver School of Medicine, USA Carina is currently an Assistant Professor of Paediatrics, Section of Allergy and Immunology at the Children’s Hospital Colorado and University of Colorado Denver School of Medicine, where she is conducting research and working with children and adults with a range of food allergies.
Kate Maslin PhD RD Research Fellow at the University of Southampton, UK
For full article references please email info@ networkhealth group.co.uk
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In this article, Carina and Kate report on a survey that was conducted with users of an electronic smartphone application specifically designed for the management of food allergies in adults. The prevalence of food allergies in children range between 0.1-6.0% in Europe,1 and 1.1-10.4% worldwide.2 Prevalence data on adult food allergies is scarce and no data establishing the true prevalence of food allergies in adults exists.2 Diet plays a crucial role in the management of food allergies. Although the dietary management of food allergy extends beyond individualised allergen avoidance, this aspect will always remain the most important part of patient management.3 Recent studies clearly indicate that food allergies affect quality of life. This is also true for those with self-reported food allergies/ intolerances, who avoid foods due to perceived symptoms.4 Food allergy affects quality of life (QoL) in four domains: food anxiety, emotional impact, social and dietary limitations.5 Venter et al4 found that there was no difference in QoL in those trying to avoid food due to a perceived or proven food allergy (p = 0.062), clearly indicating the burden of food avoidance in both groups. In addition, Greenhawt et al6 showed that anaphylaxis, multiple food allergies and food allergies other than just peanuts or tree nuts were associated with a significantly worse QoL score, most likely due to the vigilance required to avoid the trigger foods. Adhering to a restrictive diet can also affect the time taken to shop and the cost of buying food.7 Wolf et al8 showed that the average weekly price of the six food exclusion diet (SFED) at a standard US supermarket was $92.54
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compared to $79.84 for an unrestricted diet (p = 0.0001). Patients also often had to visit a second specialist grocery store to obtain all the foods needed. Food allergy and nutrition related papers mention that the future of food allergy management should include the use of electronic diaries and software applications to improve patient food intake and nutritional care.9 One of the questions we raised, however, was whether these technologies truly benefit our patients/clients. SPOON GURU
We report below about a brief survey that was conducted with UK users of the electronic smartphone application, Spoon Guru (SG). SG is available in the UK and has just launched in the US (see www.spoon.guru/app for more details). This smartphone application allows the user to find products which match the individual’s dietary requirements, through barcode scanner and search functionality. In order to instil cooking skills and prevent unnecessary reliance on packaged food, the smartphone application also provides recipes matched to the individual’s dietary needs. The smartphone application contains pre-set lifestyle and allergen/intolerance dietary options for the user to select. The list of lifestyle options to choose from include vegan, vegetarian, ovovegetarian, lacto-vegetarian, pescatarian, palm oil free, paleo, organic, low sugar, low salt, low fat and yeast avoidance. The list of allergen options to choose from include the 14 major allergens as identified by the European Union, as
The smartphone application contains pre-set lifestyle and allergen/intolerance dietary options for the user to select. well as other allergens or causes of intolerances as requested by Spoon Guru users. This, for example, includes pulses, beans and peas and SFED. The app allows for extra refinement, for example, you can exclude specific types of nuts, fish, shellfish, beans and gluten containing grains. In addition, if your intolerance is not as severe as a food allergy and you can tolerate trace amounts within your food, you can allow products that have a precautionary ‘may contain’ allergen statement on the label. Current users of the smartphone application (SG app) were asked to complete a very basic 10-question electronic questionnaire between April 2017 and August 2017. SURVEY RESULTS
One hundred and sixty three SG app users completed the survey; 63 (38.7%) with food allergies (FA) or intolerances (FI) or both (FAI) (25 FA, 29 FI and nine FAI) and 100 (61.3%) using the SG app due to personal preferences, lifestyle or other reasons. The survey was completed by 32 males (22.1%) and 172 females (77.9%). The age ranges were: 17 years or younger (6, 3.7%), 18-24 years (12, 7.4%), 25-34 years (32, 19.6%), 35-44 years (39, 23.9%), 45-54 years (45, 27.6%), 55-64 years (16, 9.8%), 65-74 years (11, 6.7%) and 75 years or over (2, 1.2%). For the analysis, we have grouped those with food allergies and/or intolerances (FAI) in one group and compared them against those using the SG due to personal preferences (lifestyle and/or other: LSO). The data is summarised in Table 1. Recoding all the variables in two categories, with the lower three options together (e.g. not at all difficult, a little difficult and somewhat difficult as one variable/option vs quite a bit difficult and very difficult as one variable/option), we found no statistical differences between the answers provided by the FAI group vs the LSO group, the female demographic vs the male, or those 34 years and younger vs those 35 years and older. However, significant differences related to QoL were found. Women indicated that the SG app was more effective in reducing difficulties with shopping
(57% women vs 34% men; Chi square test p-value: 0.037). In addition, women found the recipes more helpful than men (55% females vs 33% men; Chi square test p-value: 0.024) and stated that the SG app was more helpful in improving their QoL than men (74% females vs 42% men; Chi square test p-value < 0.001). Comparing the before and after answers relating to difficulty shopping between the FAI group and the LSO group (question 2 and question 3) showed that the ease of shopping improved significantly for both groups (McNemar’s test: FAFI P<0.001 and LFO p-value <0.001). In the FAI group, 33% (21/63) found shopping difficult before the SG app and only 1.6% (1/63) afterwards. In the LSO group, 23% (23/100) found shopping difficult before using the SG app and 1% (1/100) after using the SG app. IN SUMMARY
Suffering from food allergies, intolerances or even a self-perceived need to avoid certain foods can negatively affect QoL. Two of the main factors include the difficulty as well as the time required to shop for suitable foods. Smartphone applications may assist in making shopping experiences more positive. We set out to determine how the SG app was perceived by its users. Our findings indicate that the SG app significantly reduced difficulties encountered during shopping, but that men may have particular requirements that require further investigation. This survey was conducted in a 10-question simple format with a relatively small sample size. Longer, more in-depth surveys with larger numbers are required to get a better idea of the individual needs of users and how smartphone apps can be improved. www.NHDmag.com November 2017 - Issue 129
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NHD-EXTRA: RESEARCH & RESOURCES Table 1: Comparison of Spoon Guru users with food allergies and/or intolerances vs those using the smartphone application for personal preferences Subset with food allergies and intolerances (n=63) n(%)
Those using the app for lifestyle or other reasons (n=100) n(%)
Before using the smartphone app, how difficult was it to access information on foods that may be unsuitable or problematic? Not at all difficult
2 (3.2)
4 (4.0)
A little bit difficult
21 (33.3)
29 (29)
Somewhat difficult
19 (30.2)
44 (44.0)
Quite a bit difficult
11 (17.5)
19 (19.0)
Very difficult
10 (15.9)
4 (4.0)
How difficult is it for you now to access information on unsuitable or problematic foods now that you are using the smartphone app? Not at all difficult
22 (34.9)
34 (34.0)
A little bit difficult
33 (52.4)
52 (52.0)
Somewhat difficult
7 (11.1)
13 (13.0)
Quite a bit difficult
0 (0)
0 (0)
1 (1.6)
1 (1.0)
Very difficult
How much easier is it to shop since using the smartphone app? Not at all easier
6 (9.5)
4 (4.0)
A little bit easier
16 (25.4)
34 (34.0)
Moderately easier
10 (15.9)
8 (8.0)
Quite a bit easier
24 (38.1)
37 (37.0)
7 (11.1)
17 (17.0)
Very easy
How helpful are the recipes provided by the smartphone app? Not at all helpful
5 (7.9)
6 (6.0)
A little helpful
15 (23.8)
18 (18.0)
Moderately helpful
13 (20.6)
24 (24.0)
Quite a bit helpful
23 (36.5)
34 (34.0)
7 (11.1)
18 (18.0)
Very helpful
What do you like best about the smartphone app? (More than one choice allowed.) Less stress or frustration
22 (34.9)
30 (30.0)
Time or cost saving
17 (27.0)
22 (22.0)
Safety and peace of mind
39 (61.9)
52 (52.0)
More choice
15 (23.8)
16 (16.0)
None/other
3 (4.8)
7 (7.0)
Overall, did the smartphone app improve your quality of life? Not at all
6 (9.5)
11 (11.0)
A little
14 (22.2)
34 (34.0)
Moderately or somewhat
16 (25.4)
24 (24.0)
Quite a bit
21 (33.3)
25 (25.0)
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www.NHDmag.com November 2017 - Issue 129