Nutrition Enhancement in Early Psychosis (Neep): A Feasibility Trial of Enhanced Nutrition with Text Messaging and a Dietary Tracking Mobile Application

Abstract

Background. People with psychotic disorders tend to die earlier than the general population, primarily due to preventable cardiovascular disease. Behavioral risk factors, such as poor diet, have been identified as major contributors. Given the importance of prevention, the early stages of psychosis have been described as a “critical” time to intervene on health behaviors. As such, a mobile-based intervention, Nutrition Enhancement in Early Psychosis (NEEP) was created to improve diet quality in persons with early psychosis. This study has three aims: (1) assess the feasibility of the intervention, (2) examine preliminary outcomes, and (3) investigate mechanisms associated with dietary change. Methods. NEEP incorporates a combination of nutrition education, goal setting, and mobile technology (i.e., a mobile application for dietary tracking, as well both automated and personalized text-messages). Given the pilot nature of the study, all participants (N=15) received the intervention. Feasibility was assessed through different metrics related to recruitment and adherence to the dietary tracking application, as well as self-report responses regarding acceptability. Preliminary outcomes (i.e., two measures of diet quality) and potential mechanisms of change (i.e., self-efficacy and motivation) were also evaluated using paired sample t-tests. Qualitative interviews were conducted following study participation. Given the emphasis on feasibility with a small sample, all significance tests were set at p <.10, and Hedges g was used to examine effects over time. Results. 15 participants were enrolled in the study and 12 participants completed follow-up assessments. Evaluative measures of feasibility suggest that the majority of those who were screened enrolled in this intervention and regularly engaged with the mobile tracking device to record their dietary consumption. In addition, participants enjoyed the intervention and found it to be useful in improving their diet. Preliminary evidence also suggests this intervention may improve diet quality. As such, one indicator of improvement in diet quality was considered significant (Rapid Eating Assessment for Participants- Shortened; p=.084), and both measures of diet quality suggested improvement in diet at the end of the 28-day intervention with small to medium effect sizes (REAP-S g=.44; Heathy Eating Index-2015 g=.69). Contrary to hypotheses, self-efficacy significantly decreased after the intervention (p=.028) and motivation remained relatively stable. Conclusion. Results suggest that NEEP is feasible as a low-cost, low-resource mobile intervention that is well-tolerated and may improve diet quality in people with early psychosis; however, mechanisms of change require further exploration.