While dietary assessment has its origins as a research tool, evidence shows that the process of monitoring itself can help people to eat better. But we know that accurate dietary monitoring can sometimes feel like a mammoth task (and that’s where digital nutritional analysis tools like myfood24 can help to save time), for both patients and healthcare professionals. So, can diet tracking actually make a difference?
In this blog, we explain how dietary self-monitoring can lead to improved eating habits through behaviour change techniques (BCTs) and how digital diet-tracking tools can help you to support your patients.
Should I introduce dietary monitoring for my patients?
Dietary self-monitoring and assessment is important because it enables patients to benchmark their current diets against dietary guidelines. The data from dietary monitoring provides evidence for the need to change and quantifies the degree of change needed. This is a useful starting point for patient education, formulating a plan of action, and for measuring ongoing progress and success.
Evidence supports that dietary monitoring can lead to improved eating behaviours. For example, a systematic review showed that studies using digital self-monitoring tools helped people to increase their fruit and vegetable intake by a small yet significant amount. Another study found frequent self-monitoring to be beneficial across a range of nutritional outcomes, including saturated fat and refined grains.
That’s why NICE guidance encourages the use of dietary self-monitoring for diabetes, adult social care, and weight management to support patients to eat better for optimal health.
Population dietary guidelines are a helpful starting point, but they aren’t suitable for everyone. When caring for patients with specific dietary needs, a person-centred approach is important to meet each patient’s individual requirements. But whatever your goals, dietary monitoring is key to tracking progress towards them.
The theory of behaviour change
While there are several behaviour change models out there, the transtheoretical (stages of change) model offers a helpful reminder that behaviour change is a journey, and a non-linear one at that. It describes behaviour change as a cycle of 6 stages:
- Precontemplation – individuals have no intention to make a change and may be unaware of the need to change
- Contemplation – individuals are aware of a need to change but are not yet committed to it
- Preparation – individuals have an intention to change and may be planning steps to make it happen
- Action – individuals are committed and taking action to make a change
- Relapse – despite taking action to make a change, it takes time to make new habits stick. Individuals often revert back to old ways, even if only temporarily
- Maintenance – changes are sustained and a new behaviour has been developed through repeated action
You may well recognise some of your own patients in each of these stages of change. And you’ve probably seen people relapse, or move back and forth between stages. That’s all totally normal.
So how can dietary monitoring support patients to move towards maintenance of sustained behaviours?
A whole host of different behaviour change techniques have been identified. In fact, a few years ago, a group of researchers came up with a taxonomy of diet and physical activity behaviour change techniques (BCTs) which listed 40 different techniques in total!
Research suggests that combining different BCTs is more effective than using them in isolation. myfood24 does just that.
how myfood24 utilises behaviour change techniques to support dietary monitoring
The very act of self-monitoring is identified as a BCT in its own right. Monitoring has an important role in building up patients’ knowledge and health literacy.
We know from research that the mindfulness that comes with being monitored or observed can cause temporary behaviour changes described as the Hawthorne effect.
Dietary awareness is important for the contemplation stage and acts as an enabler for conversations about change which help people move to preparation.
What’s more, self-monitoring builds a sense of empowerment, supporting goal setting, action planning, and progress monitoring throughout each stage of change.
Prompts are an important technique for habit-forming as they encourage repetition of positive behaviours and promote adherence. myfood24 enables patients to set their own daily prompts at a time which suits them, boosting their autonomy and buy-in.
With reminders to submit incomplete diaries and monthly prompts for inactivity, myfood24 helps to embed self-monitoring as an ongoing practice.
Prompts for commonly omitted foods (e.g. ‘did you add milk?’) and visual prompts for portion sizes also help to improve the accuracy of the dietary record.
Setting goals is important for the preparation stage as goals signify an intention to change and enable monitoring as the patient moves to action. Goal-setting can take two forms.
1. Behavioural goals: these describe the overall direction of change, such as ‘I want to consume more iron’.
2. Outcome goals: allow you to quantify these goals, for example ‘I want to consume the recommended 1.48mg of iron each day’ and monitor progress against them.
myfood24’s data reports facilitate both types of goal setting. Nutrient-specific goals can be set by the healthcare professional to meet an individual’s outcome goal. This can be particularly helpful where a patient’s condition means national recommendations aren’t suitable for them, or where the use of incremental targets allows goals which feel more realistic. Both patients and healthcare professionals are then able to monitor the patient’s progress against these goals over time.
4. Action planning
Action planning enables goals to be put into action and facilitates movement from the preparation stage to the action stage.
Action planning involves developing a detailed plan for how the goal will be achieved, identifying the what, when and where. For example, ‘I will increase my iron intake by including leafy green vegetables into home-cooked dinners three times per week’.
Through user-friendly data views, myfood24 enables you to identify which meals or foods contribute most or least to a nutrient target, highlighting opportunities for action. Whether it’s a small change at breakfast or watching weekend alcohol intake.
myfood24 also allows you to assign meal plans to your patients, giving them the tools and inspiration to put their nutrition plans into action.
5. Personalised feedback
Personalised feedback has been identified as a key component for dietary behaviour change, as it enhances engagement in the information provided and supports self-regulation. Digital tools allow personalised feedback to be delivered in real-time.
All feedback provided to myfood24 users is personalised; nutritional intake is calculated from the data they enter, and is presented against their own personal nutrient goals.
Personalised feedback enables the translation of knowledge to action. For example, in a study of myfood24 users with gestational diabetes, patients found instant data summaries a motivating influence for future food choices and portion sizes.
Thinking of going digital with dietary self-monitoring?
If you’re considering digital support for your patients, here are some important factors to consider.
- Patient engagement – Patients find digital tools convenient and easy to use, making them more likely to adhere to interventions. Engagement is one of the greatest barriers for dietary behaviour change.
- Inclusivity – Digital tools enable patients to engage how and when they wish. Without the barriers of stigma, finances and travel to clinic, digital self-monitoring can better support people from low income and ethnic minority groups, who are typically less likely to attend in-person support.
- Wide reach – With lower costs, lower time commitments, and higher uptake and completion rates, digital tools can provide a cost-effective way to offer support to many more patients.
- Inclusivity – While younger generations display a preference for digital, technology can be a barrier for older patients and those with physical or learning disabilities. Additional guidance and support are likely needed for these groups.
- The need for further support – Evidence shows that digital support works best when supplemented with support from a healthcare professional. myfood24 enables continued support outside of the clinic via the notes feature. Through notes, you can respond directly to your patients through the app, providing feedback, motivation and a starting point for in-clinic conversations.
- Long-term – The use of digital tools is still in its infancy. The longer-term impacts of digital dietary support are unknown. However, research shows a key part of successful long-term weight loss with digital tools lies with patients having a strong relationship with their healthcare professional, which myfood24 aims to promote.
Dietary self-monitoring is important because it enables patients to recognise a need for change, identify how change can be achieved, and monitor progress towards their dietary targets.
Research shows that dietary monitoring can lead to behaviour change. Digital diet and nutrient tracking tools in particular have a role for widening patient reach and engaging hard-to-reach groups.
myfood24 is a digital diet tracking and nutrient analysis tool that has been developed with behaviour change techniques in mind to support patient and healthcare professional needs, ultimately to help people live healthier lives.
If you’d like to learn more about behaviour change techniques, EUFIC has a fantastic summary.