The Investigation of Nutritional Knowledge, Attitudes, Practices, Dietary Achievement, and Satisfaction among Patients with Colorectal Cancer Post-Using a Web Application: A Quasi-Experimental Study

Authors

Pornpimon Nunthanawanich, Doctoral of Public Health (International Program), Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
Sanit Wichansawakun, Division of Clinical Nutrition, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120
Cholrit Luangjinda, Research and Development Office, Thailand Institute of Occupational Safety and Health, Ministry of Labor, Bangkok 10170, Thailand
Chatrapa Hudthagosol, Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok 10400, ThailandFollow

Abstract

Background: Colorectal cancer (CRC) is a major global health concern, with malnutrition being a leading cause of death among Thai cancer patients. Misinformation, lack of knowledge, and false beliefs contribute to nutrition-related issues. Online platforms offer an alternative for patient education. This study aimed to compare the impact of two nutritional education tools, the Nutrition Educational Prototype based on Smartphone Web Applications (NEPSA) and standard hospital leaflets with nutrition counselling, on nutrition knowledge, attitudes, and practices in malnourished patients with CRC undergoing chemotherapy.

Method: This quasi-experimental study employed pretest and posttest designs with a nonequivalent control group. Twenty-eight patients with a body mass index under 20 were included in the study. NEPSA was given to 13 participants, while the standard hospital leaflet was given to 15 participants. Knowledge, attitudes, practices, calories intake, protein intake, and satisfaction with the two educational tools were assessed before and after the intervention.

Results: All parameters significantly improved after the intervention, with the intervention group showing significantly higher knowledge levels. The intervention group also met nutrition goals for calorie and protein intake within three visits, following European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines. Satisfaction with NEPSA among the intervention group was high (98%) after three visits.

Conclusions: Implementing NEPSA led to improved nutrition knowledge, attitudes, and practices, highlighting the potential of web-based nutritional guidance. Access to Thai nutrition information through NEPSA could have positive implications on a national scale.

Keywords: Colorectal cancer, Malnutrition, Nutrition web application, Thailand

Recommended Citation

Nunthanawanich P, Wichansawakun S, Luangjinda C, Hudthagosol C. The Investigation of Nutritional Knowledge, Attitudes, Practices, Dietary Achievement, and Satisfaction among Patients with Colorectal Cancer Post-Using a Web Application: A Quasi-Experimental Study. J Health Res. 2025; 39(2):-. DOI: https://doi.org/10.56808/2586-940X.1129

References

[1] Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut 2023 Feb;72(2):338e44. https://doi.org/10. 1136/gutjnl-2022-327736.

[2] Lohsiriwat V, Chaisomboon N, Pattana-Arun J. Current colorectal cancer in Thailand. Ann Coloproctol 2020 Apr; 36(2):78e82. https://doi.org/10.3393/ac.2020.01.07.

[3] Wongseree P, Hasgul Z, Leerapan B, Iramaneerat C, Phisalprapa P, Jalali MS. Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand. Prev Med 2023 Oct;175:107694. https://doi.org/10.1016/j.ypmed.2023.107694.

[4] Fan Y, Yao Q, Liu Y, Jia T, Zhang J, Jiang E. Underlying causes and co-existence of malnutrition and infections: an exceedingly common death risk in cancer. Front Nutr 2022 Feb 23;9:814095. https://doi.org/10.3389/fnut.2022.814095.

[5] Argiles JM. Cancer-associated malnutrition. Eur J Oncol Nurs 2005 Jan;9:S39e50. https://doi.org/10.1016/j.ejon.2005. 09.006.

[6] Johnson SB, Parsons M, Dorff T, Moran MS, Ward JH, Cohen SA, et al. Cancer misinformation and harmful information on facebook and other social media: a brief report. J Natl Cancer Inst 2022 Jul 11;114(7):1036e9. https://doi.org/ 10.1093/jnci/djab141.

[7] Chen L, Wang X, Peng TQ. Nature and diffusion of gynecologic cancererelated misinformation on social media: analysis of tweets. J Med Internet Res 2018 Oct;20(10):e11515. https://doi.org/10.2196/11515.

[8] Sonmez O, Tezcanli E, Bas D, Kazanci HB, Altinok A, Demir A, et al. Identifying knowledge and practices regarding cancer patient malnutrition: a survey study among oncologists. Nutr Cancer 2022 Jun;74(7):2392e9. https://doi. org/10.1080/01635581.2021.2008987.

[9] Browne S, Geraghty A, Corish C. Advances in knowledge of screening practices and their use in clinical practice to prevent malnutrition. Proc Nutr 2022 Mar;81(1):41e8. https:// doi.org/10.1017/S0029665121003670.

[10] Mossman J, Boudioni M, Slevin ML. Cancer information: a cost-effective intervention. Eur J Cancer 1999 Oct;35(11): 1587e91. https://doi.org/10.1016/S0959-8049(99)00195-1.

[11] Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the digital age: A blessing or a curse? Int J Environ Res Public Health 2021 Aug;18(16):8302. https://doi.org/10.3390/ijerph18168302.

[12] Mbunge E, MuchemwaB,Batani J. Sensors and healthcare 5. 0: transformative shift in virtual care through emerging digital health technologies. Glob Health 2021 Dec;5(4): 169e77. https://doi.org/10.1016/j.glohj.2021.11.008.

[13] Horgan D, Romao M, Morre SA, Kalra D. Artificial intelligence: power for civilisation- and for better healthcare. Public Health Genomics 2019;22(5e6):145e61. https://doi. org/10.1159/000504785.

[14] Ibrahim H, Liu X, Zariffa N, Morris AD, Denniston AK. Health data poverty: an assailable barrier to equitable digital health care. Lancet Digit Health 2021 Apr;3(4):e260e5. https://doi.org/10.1016/S2589-7500(20)30317-4.

[15] Mahmood S, Hasan K, Colder Carras M, Labrique A. Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health. JMIR Public Health Surveill 2020 Apr 16;6(2):e18980. https://doi.org/10.2196/18980.

[16] Martin B, Cereda E, Caccialanza R, Pedrazzoli P, Tarricone R, Ciani O. Cost-effectiveness analysis of oral nutritional supplements with nutritional counselling in head and neck cancer patients undergoing radiotherapy. Cost Eff Resour Alloc 2021 Jun 15;19(1):35. https://doi.org/10.1186/s12962021-00291-7.

[17] Thomson KH, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, et al. Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. Lancet Healthy Longev 2022 Oct;3(10): e654e66. https://doi.org/10.1016/S2666-7568(22)00171-4.

[18] Ministry of Digital Economy and Society. Summary of household survey on the use of information and communication technology. Bangkok: National Statistic Office; 2022 [cited 2024 May 23]. Available from: https://www.nso.go.th/ nsoweb/nso/survey_detail/jJ?set_lang¼th.

[19] Mirkovic J, Kaufman DR, Ruland CM. Supporting cancer patients in illness management: usability evaluation of a mobile app. JMIR Mhealth Uhealth 2014 Aug 13;2(3):e33. https://doi.org/10.2196/mhealth.3359.

[20] Zheng C, Chen X, Weng L, Guo L, Xu H, Lin M, et al. Benefits of mobile apps for cancer pain management: systematic review. JMIR Mhealth Uhealth 2020 Jan 23;8(1):e17055. https://doi.org/10.2196/17055.

[21] Davis SW, Oakley-Girvan I. Achieving value in mobile health applications for cancer survivors. J Cancer Surviv 2017 Aug; 11(4):498e504. https://doi.org/10.1007/s11764-017-0608-1.

[22] Greer JA, Jacobs JM, Pensak N, Nisotel LE, Fishbein JN, MacDonald JJ, et al. Randomized trial of a smartphone mobile app to improve symptomsandadherence to oral therapy for cancer. J Natl Compr Canc Netw 2020 Feb;18(2):133e41. https://doi.org/10.6004/jnccn.2019.7354.

[23] Penedo FJ, Oswald LB, Kronenfeld JP, Garcia SF, Cella D, Yanez B. The increasing value of eHealth in the delivery of patient-centred cancer care. Lancet Oncol 2020 May;21(5): e240e51. https://doi.org/10.1016/S1470-2045(20)30021-8.

[24] Ngubelanga A, Duffett R. Modeling mobile commerce applications’ antecedents of customer satisfaction among millennials: An extended tam perspective. Sustainability 2021 May;13(11):5973. https://doi.org/10.3390/su13115973.

[25] Chan ZY, Lim CF, Leow JL, Chium FY, Lim SW, Tong CH, et al. Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting. Proceedings of Singapore Healthcare31; 2022. https://doi.org/10.1177/20101058221104578.

[26] Orlemann T, Reljic D, Zenker B, Meyer J, Eskofier B, Thiemt J, et al. A novel mobile phone app (OncoFood) to record and optimize the dietary behavior of oncologic patients: pilot study. JMIR cancer 2018 Nov;4(2):e10703. https:// doi.org/10.2196/10703.

[27] Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr 2021 May;40(5): 2898e913. https://doi.org/10.1016/j.clnu.2021.02.005.

[28] Pichardo MS, Sanft T, Ferrucci LM, Romero-Ramos YM, Cartmel B, Harrigan M, et al. Diet and physical activity interventions in Black and Latina women with breast cancer: A scoping review. Front Oncol 2023 Mar 13;13:1079293. https:// doi.org/10.3389/fonc.2023.1079293.

[29] Salihah N, Lua PL, Ahmad A, Shahril MR. “CandiTm”:A Malaysian-tailored dietary smartphone app for cancer patients and survivors. Malaysian Journal of Public Health Magazine 2017;2:32e40. http://eprints.unisza.edu. my/741/.

[30] Çõnar D, Karadakovan A, Erdogan AP. Effect of mobile phone app-based training on the quality of life for women with breast cancer. Eur J Oncol Nurs 2021 Jun;52:101960. https://doi.org/10.1016/j.ejon.2021.101960.

[31] Potdar R, Thomas A, DiMeglio M, Mohiuddin K, Djibo DA, Laudanski K, et al. Access to internet, smartphone usage, and acceptability of mobile health technology among cancer patients. Support Care Cancer 2020 Nov;28(11):5455e61. https://doi.org/10.1007/s00520-020-05393-1.

[32] Hojati Z, Goudarzi F, Hasanvand S, Galehdar N, Birjandi M. The impact of training chemotherapy safety standards with a smartphone application on the knowledge, attitude, and performance of nurses. BMC Nurs 2023 Feb;22(1):43. https:// doi.org/10.1186/s12912-023-01199-8.

[33] Xie J, Zhang C, Li S, Dai R, Deng B, Xu Q, et al. Knowledge, attitudes, and practices toward cancer pain management amongst healthcare workers (physicians, pharmacists, and nurses): a cross-sectional study from first-tier cities in China. Support Care Cancer 2022 Sep;30(9):7261e9. https://doi.org/ 10.1007/s00520-022-07139-7.

[34] Yaacob NA, MohamadMarzukiMF,YaacobNM,AhmadSB, Abu Hassan MR. Effectiveness of the colorapp mobile app for health education and promotion for colorectal cancer: quasi-experimental study. JMIR Hum Factors 2020 Feb 25; 7(1):e15487. https://doi.org/10.2196/15487.

[35] Steeb T, Wessely A, Mastnik S, Brinker TJ, French LE, Niesert AC, et al. Patient attitudes and their awareness towards skin cancer-related apps: cross-sectional survey. JMIR Mhealth Uhealth 2019 Jul 2;7(7):e13844. https://doi.org/10. 2196/13844.

[36] Heynsbergh N, Heckel L, Botti M, Livingston PM. Development of a smartphone app for informal carers of people with cancer: processes and learnings. JMIR Form Res 2019 Apr;3(2):e10990. https://doi.org/10.2196/10990.

[37] Lozano-Lozano M, Cantarero-Villanueva I, Martin-Martin L, Galiano-Castillo N, Sanchez MJ, Fernandez-Lao C, et al. Amobilesystemto improvequality of life via energy balance in breast cancer survivors (BENECA mHealth): prospective test-retest quasiexperimental feasibility study. JMIR Mhealth Uhealth 2019 Jun 25;7(6):e14136. https://doi.org/10.2196/ 14136.

[38] Siebenhüner AR, Mikolasek M, Witt CM, Barth J. Improvements in health might contradict adherence to mobile health interventions: findings from a self-care cancer app study. J Altern Complement Med 2021 Mar;27(S1):S-115. https:// doi.org/10.1089/acm.2020.0111.