Background: Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. Method: Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. Results: The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20–30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. Discussion: We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.

This work aimed to identify clinical practice guidelines (CPGs) that include recommendations for the prevention, diagnosis, and treatment of women’s malnutrition during pregnancy and to evaluate the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. We conducted a literature review using PubMed and different websites from January 2009 to February 2021. The quality of the CPGs was independently assessed by reviewers using the AGREE II instrument, which defines guidelines scoring >70% in the overall assessment as “high quality”. The analysis included 43 guidelines. Among the main findings, we identified that only half of the CPGs (51.1%) obtained a final “high quality” evaluation. AGREE II results varied widely across domains and categories. The two domains that obtained the highest scores were scope and purpose with 88.3% (range 39 to 100%) and clarity of presentation with 87.2% (range 25 to 100%). Among the “high quality” CPGs, the best scores were achieved by the three guidelines published by the National Institute of Health and Care Excellence (NICE) and the World Health Organization (WHO). Due to the importance of maternal nutrition in pregnancy, it is essential to join forces to improve the quality of the guidelines, especially in CPGs that do not meet the reference standards for quality.

In this study, we explore how to use household expenditures and income surveys (HEIS) to provide replicable and comparable measures of nutrients availability at the population level. Our method formalizes the common practice in the literature and consists of three steps: identification of relevant food categories, pairing of food contents food groups in HEIS data, and calculation of the typical amount of nutrients by food group. We illustrate the usage of the method with Mexican data and provide a publicly available data set to readily convert food purchases into six nutrients: calories, proteins, vitamins A and C, iron, and zinc. We perform a descriptive analysis of the evolution of nutrients intake among Mexican households between 2008 and 2020, considering differences by income level. Our results reflect the effect of the COVID-19 pandemic on nutrient availability in Mexican households, mainly driven by a substantial reduction in the expenditure in food consumed away from home, although for most nutrients the trend was stable over most of the period.

BACKGROUND In Mexico, the maternal and child population continues to face a high burden of malnutrition, posing a persisted public health challenge. The healthcare system plays a crucial role, not only in addressing existing cases but also in preventing and detecting malnutrition early. Mobile health (mHealth) technologies have the potential to strengthen maternal and child health services by improving the quality, accessibility, and timeliness of nutritional care. OBJECTIVE The aim was to develop and validate the design and content of a mobile application—CANMI (Calidad de la Atención Nutricional Materno Infantil, by its Spanish acronym) — to monitor the quality of maternal and child nutritional care in primary health care units in Mexico. METHODS The framework of the CANMI app was based on the 16 validated indicators designed to assess the quality of nutritional care during the preconception, pregnancy, postpartum, early childhood, and preschool stages. The application was developed for both iOS and Android systems using a user-centered design approach. Following development, a pilot usability study was conducted in a randomized sample of 18 primary health care units in Guanajuato, Mexico. Trained nutritionists implemented the app and collected usability data at the end of the initial usage period and again six weeks later. To further explore user experience, semi-structured online interviews were conducted to identify barriers, facilitators, and overall satisfaction with the app. RESULTS The CANMI app allows the systematic registration of key indicators to assess the quality of nutritional care in primary health care settings. Users described the app as simple, intuitive, and visually appealing. Overall usability was rated positively, with a mean score of 71.13 on the System Usability Scale (SUS) indicating good acceptability. The app’s offline functionality, streamlined interface, and efficiency in data collection were identified as key facilitators of use. Reported benefits included reduced time for data entry and perceived improvements in the quality of nutritional care. Identified barriers to integration included the need to use personal devices, user fatigue due to prolonged screen time, inconsistent clinical records, and limited time to incorporate the app into routine workflows. Importantly, the app encouraged promoted improvements in documentation practices and heightened awareness among health personnel regarding the precision and clarity of their nutritional recommendations. CONCLUSIONS The CANMI app provides a feasible and effective solution for monitoring the quality of maternal and child nutritional care in primary health settings. Its high usability and offline capabilities make it particularly suitable for low-connectivity environments. Beyond facilitating data collection, the app contributed to improved clinical documentation practices and enhanced provider awareness of care quality. As such, the application can represent a promising digital tool to support the implementation evidence-based, user-centered strategies aimed at strengthening maternal and child health services in resource- limited contexts. CLINICALTRIAL The study protocol was reviewed and approved by the Research Ethics Committee of the Universidad Iberoamericana in Mexico City (172/2022).

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: In Mexico, the maternal and child population continues to face a high burden of malnutrition, posing a persisted public health challenge. The healthcare system plays a crucial role, not only in addressing existing cases but also in preventing and detecting malnutrition early. Mobile health (mHealth) technologies have the potential to strengthen maternal and child health services by improving the quality, accessibility, and timeliness of nutritional care. Objective: The aim was to develop and validate the design and content of a mobile application—CANMI (Calidad de la Atención Nutricional Materno Infantil, by its Spanish acronym) — to monitor the quality of maternal and child nutritional care in primary health care units in Mexico. Methods: The framework of the CANMI app was based on the 16 validated indicators designed to assess the quality of nutritional care during the preconception, pregnancy, postpartum, early childhood, and preschool stages. The application was developed for both iOS and Android systems using a user-centered design approach. Following development, a pilot usability study was conducted in a randomized sample of 18 primary health care units in Guanajuato, Mexico. Trained nutritionists implemented the app and collected usability data at the end of the initial usage period and again six weeks later. To further explore user experience, semi-structured online interviews were conducted to identify barriers, facilitators, and overall satisfaction with the app. Results: The CANMI app allows the systematic registration of key indicators to assess the quality of nutritional care in primary health care settings. Users described the app as simple, intuitive, and visually appealing. Overall usability was rated positively, with a mean score of 71.13 on the System Usability Scale (SUS) indicating good acceptability. The app’s offline functionality, streamlined interface, and efficiency in data collection were identified as key facilitators of use. Reported benefits included reduced time for data entry and perceived improvements in the quality of nutritional care. Identified barriers to integration included the need to use personal devices, user fatigue due to prolonged screen time, inconsistent clinical records, and limited time to incorporate the app into routine workflows. Importantly, the app encouraged promoted improvements in documentation practices and heightened awareness among health personnel regarding the precision and clarity of their nutritional recommendations. Conclusions: The CANMI app provides a feasible and effective solution for monitoring the quality of maternal and child nutritional care in primary health settings. Its high usability and offline capabilities make it particularly suitable for low-connectivity environments. Beyond facilitating data collection, the app contributed to improved clinical documentation practices and enhanced provider awareness of care quality. As such, the application can represent a promising digital tool to support the implementation evidence-based, user-centered strategies aimed at strengthening maternal and child health services in resource- limited contexts. Clinical Trial: The study protocol was reviewed and approved by the Research Ethics Committee of the Universidad Iberoamericana in Mexico City (172/2022).