A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study

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Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for personal computers and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure the PortfolioDiet.app meets the needs of its target end-users. Objective: The main objective of this project was to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project between February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, dietitians, and nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for seven days. In phase 1, a mixed-form questionnaire was administered to evaluate the user’s perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative data and qualitative data including two open-ended questions. Responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale (SUS) was used to assess the usability of the updated PortfolioDiet.app, with a score of above 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included: challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed logout frustration, request for step-by-step popup windows, and request for a mobile app version; while the recipe section was the most commonly praised feature. Between the project phases, six modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average SUS score was 85.39 ± 11.47, with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app limitations and strengths were able to be identified informing modifications to the app resulting in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. While further refinements to the app will continue to be made prior to its evaluation in a clinical trial, the result of this QI project is an improved clinical tool.

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