*Rick Weiss, Phyllis Stumbo
President, Founder, and Chief Science Officer, Viocare, Inc.
Poster Presentation – Research Track
Sunday, Sept 30, 2012: 11:25 PM – 12:25 PM – LK Lower Lobby

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*Presenting Speaker

(Research In Progress)

Background
Dietary and physical activity lifestyle patterns are leading contributors to premature death. Healthcare practitioners recognize the relationship among nutrition, physical activity and health but few incorporate lifestyle counseling into routine practice. VioWell is an internet-based wellness program developed to support nutrition and physical activity counseling by physicians.  The system automates the collection and analysis of dietary and physical activity assessments and guides counseling tailored to the patient’s unique needs. The patient completes online questionnaires in the physician’s office or at home. Results from the questionnaires are used by the physician to encourage healthful lifestyle goals during subsequent visits.Dietary assessment of patients is hampered by limited time for conducting assessments and evaluation of the information, and lack of resources for the change process. Current dietary assessments (typically written food records or interviews) are limited in accuracy and value.  VioWell incorporates a new graphical data collection method that reliably assesses dietary intake. The tool, VioScreen, a web-based food frequency questionnaire (FFQ), includes 1,200 food and portion size images.  Results are immediately available and include a food pattern analysis, list of foods and nutrients consumed, and a list of practical, targeted suggestions for food changes. Goals of this study were to validate the dietary assessment component and evaluate usability of the dietary portion of the VioWell system.

Method
Nutrient intake captured by VioScreen was evaluated through an inter-method reliability study with 74 subjects conducted at Ohio State University. Nutrient intake produced by two administrations of VioScreen was compared to intake from six 24-hour recalls. A usability questionnaire was used to survey each subject about their experience with the questionnaire.  Questions included 14 factors about clarity of questions, appropriateness of the food list, helpfulness of portion-size pictures, ease of navigating the screens, screen appearance, length of the questionnaire and finally willingness to use the system as part of their medical care.

Results
The inter-method reliability was higher for VioScreen than for the paper FFQ VioScreen was modeled after and higher than reported for many other paper FFQs used in major epidemiological studies.  Of the macronutrients, accuracy only of alcohol values were similar to other questionnaires; for all other components VioScreen correlations were substantially higher, being at or above 0.80 for most macronutrients (0.90 for alcohol, 0.84 for saturated fat, 0.82 for fat, and 0.79 for carbohydrate) and 0.67 for protein.  Average time for completing VioScreen was 26.7 +/- 10.0 minutes. Participants evaluated usability as very good to excellent on ease of use and capturing foods usually consumed. All subjects rated the questionnaire as easy to use, 93% rated VioScreen as either great or excellent, and 99% would complete VioScreen if asked by a doctor.Future enhancements include tailored diet and physical activity counseling and lifestyle change messages for delivery within a healthcare environment.

Conclusions
Use of an FFQ within a healthcare system is feasible and resulting responses can be used by healthcare providers to encourage better nutrition. VioWell is efficient in saving time and delivering targeted messages designed to support lifestyle change.