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Randomized Controlled Trial
. 2025 Mar 28:9:e58124.
doi: 10.2196/58124.

Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study

Meaghan E Kavanagh  1   2 , Laura Chiavaroli  1   2   3 , Selina M Quibrantar  1 , Gabrielle Viscardi  1 , Kimberly Ramboanga  2 , Natalie Amlin  2 , Melanie Paquette  1   2 , Sandhya Sahye-Pudaruth  1   2 , Darshna Patel  1   2 , Shannan M Grant  4   5 , Andrea J Glenn  6   7 , Sabrina Ayoub-Charette  1   2 , Andreea Zurbau  1   2 , Robert G Josse  8 , Vasanti S Malik  1   7 , Cyril W C Kendall  1   2 , David J A Jenkins  1   2   3   8   9 , John L Sievenpiper  1   2   3   8   9
Affiliations
Randomized Controlled Trial

Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study

Meaghan E Kavanagh et al. JMIR Cardio. .

Abstract

Background: The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory.

Objective: We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks.

Methods: Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12.

Results: In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained.

Conclusions: Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management.

Trial registration: ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466.

Keywords: Portfolio Diet; acceptability; apps; cardiovascular disease; cholesterol reduction; diet; dietary app; dietary portfolio; eHealth; usability.

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Conflict of interest statement

Conflicts of Interest: MEK was a part-time employee at INQUIS Clinical Research, Ltd, a contract research organization. LC has received research support from the Canadian Institutes of Health Research (CIHR), Protein Industries Canada (a government of Canada Global Innovation Clusters), Alberta Pulse Growers, and the United Soybean Board (USDA soy Checkoff program). AJG has received travel support and/or honoraria from Vinasoy, the Soy Nutrition Institute Global, and the Academy of Nutrition and Dietetics. SA-C has received an honorarium from the International Food Information Council for a talk on artificial sweeteners, the gut microbiome, and the risk for diabetes. AZ is a part-time research associate at INQUIS Clinical Research, Ltd, a contract research organization. She has received consulting fees from the Glycemic Index Foundation. CWCK, DJAJ, and JLS have received funding support, honoraria, consulting, or travel fees from a broad range of food, beverage, and ingredient companies, trade associations, government agencies, health charities, private foundations, or other commercial or nonprofit entities with an interest in nutrition and chronic disease prevention and management. For a complete list of disclosures, see Multimedia Appendix 6. All other authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
PortfolioDiet.app dashboard with key features highlighted, top to bottom: (A) learn tab that has recipes, tipsheets, and videos; (B) daily average Portfolio Diet Score per month; (C) star rewards, a form of reward for logging into the app and for completing the question of the week; (D) current day total Portfolio Diet Score; (E) specific daily messages related to goals; (F) personal favorite meals for easy tracking; (G) subcategory Portfolio Diet Scores with daily targets of 5 points; (H) progress-tracking graph displaying the monthly progress of the score; and (I) leaderboard with other app users' 30-day average.
Figure 2
Figure 2
CONSORT (Consolidated Standards of Reporting Trials) flow diagram showing participant flow through the ancillary study. PortfolioEx trial: the Combined Portfolio Diet and Exercise Study; 7DDR: 7-day diet record.
Figure 3
Figure 3
Overview of main themes and subthemes identified from open-ended question responses. The number of participants with statements in each main theme is indicated by “(n=)”.
See this image and copyright information in PMC

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