Systematic Review|Articles in Press

Impact of mHealth Interventions on Supporting Dietary Adherence in Cardiovascular Disease: A Systematic Review

Published:April 25, 2023DOI:



      A systematic review was conducted to determine if mobile health (mHealth) interventions, and which intervention characteristics, effectively support dietary adherence and reduce risk factors in patients with cardiovascular disease (CVD).


      Using 7 databases, studies involving adult participants with specific CVD diagnoses, mHealth intervention testing, and dietary adherence assessment were identified. Systematic reviews, qualitative studies, or studies testing interventions involving open dialogue between participants and health care providers or researchers were excluded. Two independent reviewers conducted screening and assessed the risk of bias.


      Thirteen studies involved participants with prehypertension (n = 1), hypertension (n = 9), coronary artery disease (n = 2), and heart failure (n = 1). mHealth interventions in 8 studies improved dietary adherence, 4 showed mixed results, and 1 showed no improvements. Eight studies found interactive text and/or application-based mHealth intervention features effectively improved dietary adherence. One study had a low risk of bias, 2 had some concerns/moderate risk, and 10 had a high/critical or serious risk.


      In most included studies, mHealth interventions positively impacted dietary adherence for patients with CVD.

      Implications for Research and Practice

      Clinicians may recommend mHealth interventions to support nutrition education and self-management for their patients with CVD.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access

      SNEB Member Login

      SNEB Members, full access to the journal is a member benefit. Login via the SNEB Website to access all journal content and features.


      Subscribe to Journal of Nutrition Education and Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ezekowitz JA
        • O'Meara E
        • McDonald MA
        • et al.
        2017 Comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure.
        Can J Cardiol. 2017; 33: 1342-1433
        • Pearson GJ
        • Thanassoulis G
        • Anderson TJ
        • et al.
        2021 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult.
        Can J Cardiol. 2021; 37: 1129-1150
        • Rabi DM
        • McBrien KA
        • Sapir-Pichhadze R
        • et al.
        Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children.
        Can J Cardiol. 2020; 36: 596-624
        • Leon N
        • Charles S
        • Victoire DA
        • et al.
        Determinants of adherence to recommendations of the dietary approach to stop hypertension in adults with hypertension treated in a hospital in Benin.
        Univers J Public Health. 2015; 3: 213-219
        • Arcand J
        • Floras V
        • Ahmed M
        • et al.
        Nutritional inadequacies in patients with stable heart failure.
        J Am Diet Assoc. 2009; 109: 1909-1913
        • Arcand J
        • Ivanov J
        • Sasson A
        • et al.
        A high-sodium diet is associated with acute decompensated heart failure in ambulatory heart failure patients: a prospective follow-up study.
        Am J Clin Nutr. 2011; 93: 332-337
        • Afshin A
        • Sur PJ
        • Fay KA
        • Cornaby L
        • Ferrara G
        • Salama JS.
        Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.
        Lancet. 2019; 393: 1958-1972
        • Hosseini SH
        • Jones JM
        • Vatanparast H.
        Association between grain intake, nutrient intake, and diet quality of Canadians: evidence from the Canadian Community Health Survey-nutrition.
        Nutrients. 2015; 2019: 11
        • Tugault-Lafleur CN
        • Black JL.
        Differences in the quantity and types of foods and beverages consumed by Canadians between 2004 and 2015.
        Nutrients. 2019; : 11
        • Ling RZQ
        • Jiao N
        • Hassan NB
        • He H
        • Wang W.
        Adherence to diet and medication and the associated factors among patient with chronic heart failure in a multi-ethnic society.
        Heart Lung. 2020; 49: 144-150
        • Dash S
        • Delibasic V
        • Alsaeed S
        • et al.
        Knowledge, attitudes and behaviours related to physician-delivered dietary advice for patients with hypertension.
        J Community Health. 2020; 45: 1067-1072
        • Riegel B
        • Lee S
        • Hill J
        • et al.
        Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure.
        Heart Lung. 2019; 48: 179-185
        • Rehman H
        • Kamal AK
        • Morris PB
        • Sayani S
        • Merchant AT
        • Virani SS.
        Mobile health (mhealth) technology for the management of hypertension and hyperlipidemia: slow start but loads of potential.
        Curr Atheroscler Rep. 2017; 19: 12
      1. Government of Canada. Communications Monitoring Report 2018. Canadian Radio-television and Telecommunication Commission; 2019.

        • Schuuring MJ
        • Backx AP
        • Zwart R
        • et al.
        Mobile health in adults with congenital heart disease: current use and future needs.
        Neth Heart J. 2016; 24: 647-652
        • Treskes RW
        • Koole M
        • Kauw D
        • et al.
        Adults with congenital heart disease: ready for mobile health?.
        Neth Heart J. 2019; 27: 152-160
        • Shan R
        • Ding J
        • Plante TB
        • Martin SS.
        Mobile health access and use among individuals with or at risk for cardiovascular disease: 2018 Health Information National Trends Survey (HINTS).
        J Am Heart Assoc. 2019; 8e014390
        • Couper MP
        • Gremel G
        • Axinn W
        • Guyer H
        • Wagner J
        • West BT.
        New options for national population surveys: the implications of internet and smartphone coverage.
        Soc Sci Res. 2018; 73: 221-235
        • Baek H
        • Suh JW
        • Kang SH
        • et al.
        Enhancing user experience through user study: design of an mhealth tool for self-management and care engagement of cardiovascular disease patients.
        JMIR Cardio. 2018; 2: e3
        • Hamine S
        • Gerth-Guyette E
        • Faulx D
        • Green BB
        • Ginsburg AS.
        Impact of mhealth chronic disease management on treatment adherence and patient outcomes: a systematic review.
        J Med Internet Res. 2015; 17: e52
        • Changizi M
        • Kaveh MH.
        Effectiveness of the mhealth technology in improvement of healthy behaviors in an elderly population-a systematic review.
        mHealth. 2017; 3: 51
        • Schoeppe S
        • Alley S
        • Van Lippevelde W
        • et al.
        Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review.
        Int J Behav Nutr Phys Act. 2016; 13: 127
        • Moher D
        • Shamseer L
        • Clarke M
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1
        • Pati D
        • Lorusso LN.
        How to write a systematic review of the literature.
        HERD. 2018; 11: 15-30
        • Abraham C
        • Michie S.
        A taxonomy of behavior change techniques used in interventions.
        Health Psychol. 2008; 27: 379-387
        • Sterne JAC
        • Savović J
        • Page MJ
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
        • Sterne JAC
        • Hernán MA
        • Reeves BC
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions.
        BMJ. 2016; 355: i4919
        • Higgins JPT
        • Thomas J
        • Chandler J
        • et al.
        Cochrane Handbook for Systematic Reviews of Interventions.
        John Wiley & Sons, 2019
        • Liu S
        • Tanaka R
        • Barr S
        • Nolan RP.
        Effects of self-guided e-counseling on health behaviors and blood pressure: results of a randomized trial.
        Patient Educ Couns. 2020; 103: 635-641
        • Akhu-Zaheya LM
        • Shiyab WY.
        The effect of short message system (SMS) reminder on adherence to a healthy diet, medication, and cessation of smoking among adult patients with cardiovascular diseases.
        Int J Med Inform. 2017; 98: 65-75
        • Liu S
        • Brooks D
        • Thomas SG
        • Eysenbach G
        • Nolan RP.
        Effectiveness of user- and expert-driven web-based hypertension programs: an RCT.
        Am J Prev Med. 2018; 54: 576-583
        • Santo K
        • Hyun K
        • de Keizer L
        • et al.
        The effects of a lifestyle-focused text-messaging intervention on adherence to dietary guideline recommendations in patients with coronary heart disease: an analysis of the TEXT ME study.
        Int J Behav Nutr Phys Act. 2018; 15: 45
        • Steinberg DM
        • Kay MC
        • Svetkey LP
        • et al.
        Feasibility of a digital health intervention to improve diet quality among women with high blood pressure: randomized controlled feasibility trial.
        JMIR MHealth UHealth. 2020; 8: e17536
        • Dorsch MP
        • Cornellier ML
        • Poggi AD
        • et al.
        Effects of a novel contextual just-in-time mobile app intervention (LowSalt4Life) on sodium intake in adults with hypertension: pilot randomized controlled trial.
        JMIR MHealth UHealth. 2020; 8: e16696
        • Abu-El-Noor NI
        • Aljeesh YI
        • Bottcher B
        • Abu-El-Noor MK.
        Impact of a mobile phone app on adherence to treatment regimens among hypertensive patients: a randomised clinical trial study.
        Eur J Cardiovasc Nurs. 2021; 20: 428-435
        • Bozorgi A
        • Hosseini H
        • Eftekhar H
        • et al.
        The effect of the mobile “blood pressure management application” on hypertension self-management enhancement: a randomized controlled trial.
        Trials. 2021; 22: 413
        • Staffileno BA
        • Tangney CC
        • Fogg L.
        Favorable outcomes using an eHealth approach to promote physical activity and nutrition among young African American women.
        J Cardiovasc Nurs. 2018; 33: 62-71
        • Chen S
        • Gong E
        • Kazi DS
        • et al.
        Using mobile health intervention to improve secondary prevention of coronary heart diseases in China: mixed-methods feasibility study.
        JMIR MHealth UHealth. 2018; 6: e9
        • Golshahi J
        • Ahmadzadeh H
        • Sadeghi M
        • Mohammadifard N
        • Pourmoghaddas A.
        Effect of self-care education on lifestyle modification, medication adherence and blood pressure in hypertensive adults: randomized controlled clinical trial.
        Adv Biomed Res. 2015; 4: 204
        • Nundy S
        • Razi RR
        • Dick JJ
        • et al.
        A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study.
        J Med Internet Res. 2013; 15: e53
        • Laing SS
        • Ocampo P
        • Ocampo C
        • Caravalho J
        • Perez G
        • Baugh S.
        Provider perceptions of mhealth engagement for low-resourced, safety-net communities.
        Public Health Nurs. 2021; 38: 13-21
        • Navabi N
        • Ghaffari F
        • Jannat-Alipoor Z.
        Older adults’ attitudes and barriers toward the use of mobile phones.
        Clin Interv Aging. 2016; 11: 1371-1378
        • Pallazola VA
        • Davis DM
        • Whelton SP
        • et al.
        A clinician's guide to healthy eating for cardiovascular disease prevention.
        Mayo Clin Proc Innov Qual Outcomes. 2019; 3: 251-267
        • Yu E
        • Malik VS
        • Hu FB.
        Cardiovascular disease prevention by diet modification: JACC Health Promotion series.
        J Am Coll Cardiol. 2018; 72: 914-926
        • Head KJ
        • Noar SM
        • Iannarino NT
        • Grant Harrington N
        Efficacy of text messaging-based interventions for health promotion: a meta-analysis.
        Soc Sci Med. 2013; 97: 41-48
        • Park LG
        • Beatty A
        • Stafford Z
        • Whooley MA.
        Mobile phone interventions for the secondary prevention of cardiovascular disease.
        Prog Cardiovasc Dis. 2016; 58: 639-650
        • Michie S
        • Abraham C
        • Whittington C
        • McAteer J
        • Gupta S.
        Effective techniques in healthy eating and physical activity interventions: a meta-regression.
        Health Psychol. 2009; 28: 690-701
        • Rupasinghe WS
        • Perera H
        • Wickramaratne N.
        A comprehensive review on dietary assessment methods in epidemiological research.
        Public Health Nutr. 2020; 3: 204-211
        • Cogswell ME
        • Loria CM
        • Terry AL
        • et al.
        Estimated 24-hour urinary sodium and potassium excretion in US adults.
        JAMA. 2018; 319: 1209-1220