Quality improvement and usability testing of the PortfolioDiet.app, a web-based health application to translate nutrition therapy for cardiovascular risk reduction in primary care (Preprint)

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 objective of this project was to undertake and describe user testing of 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. For phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Between the project phases, 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 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, the result of this QI project will now be an improved clinical tool that better meets user needs. CLINICALTRIAL This QI project was formally reviewed by institutional authorities at Unity Health Toronto and deemed to neither require Research Ethics Board approval nor written informed consent from participants.