title: Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior.
abstract: BACKGROUND
  The limited or uncertain access to adequate food in elderly people includes not only economic restrictions but also inability of food utilization due to functional or cognitive impairment, health problems, and illiteracy.
  
  
  OBJECTIVE
  The aim of this work is to present the protocol of the randomized controlled trial Saúde.Come Senior, an educational and motivational television (TV)-based intervention to promote healthy lifestyles and decrease food insecurity in elderly people.
  
  
  METHODS
  A randomized controlled study will be conducted in subjects aged 60 years and older with food insecurity, identified at 17 primary care centers in the Lisboa e Vale do Tejo health region in Lisbon, Portugal. The primary outcome will be the changes in participants' food insecurity score (evaluated by the Household Food Insecurity Scale) at 3 months. Change in other outcomes will be assessed (dietary habits, nutritional status, physical activity, health status, and clinical outcomes). Subjects will be followed over 6 months; the intervention will last 3 months. Data collection will be performed at 3 different time points (baseline, end of intervention at 3 months, and follow-up at 6 months). The intervention is based on an interactive TV app with an educational and motivational program specifically developed for the elderly that has weekly themes and includes daily content in video format: (1) nutrition and diet tips for healthy eating, (2) healthy, easy to cook and low-cost recipes, and (3) physical exercise programs. Furthermore, brief reminders on health behaviors will also be broadcasted through the TV app. The total duration of the study will be 6 months. The intervention is considered to be effective and meaningful if 50% of the individuals in the experimental group have a decrease of 1 point in the food insecurity score, all the remaining being unchanged. We expect to include and randomize 282 (141 experimental and 141 control) elderly with food insecurity. We will recruit a total of 1,128 subjects considering that 50% of the target individuals are food insecure (based on INFOFAMÍLIA Survey) (567) and about 50% of those will adhere to the study (282).
  
  
  RESULTS
  The randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017.
  
  
  CONCLUSIONS
  This study will assess the efficacy of this innovative tool (Saúde.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way.
authors.affiliation: EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.|Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.|Instituto de Medicina Molecular, Rheumatology Research Unit, Lisboa, Portugal.
authors.forename: Ana Maria
authors.identifier: http://orcid.org/0000-0003-2046-8017
authors.initials: AM
authors.lastname: Rodrigues
authors.affiliation: EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.|Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.
authors.forename: Maria João
authors.identifier: http://orcid.org/0000-0002-0380-7833
authors.initials: MJ
authors.lastname: Gregório
authors.affiliation: EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Pierre
authors.identifier: http://orcid.org/0000-0003-2463-1723
authors.initials: P
authors.lastname: Gein
authors.affiliation: Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.
authors.forename: Mónica
authors.identifier: http://orcid.org/0000-0001-6762-7818
authors.initials: M
authors.lastname: Eusébio
authors.affiliation: Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.|Instituto de Medicina Molecular, Rheumatology Research Unit, Lisboa, Portugal.|Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Maria José
authors.identifier: http://orcid.org/0000-0002-7946-1365
authors.initials: MJ
authors.lastname: Santos
authors.affiliation: EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Rute Dinis
authors.identifier: http://orcid.org/0000-0001-9713-0204
authors.initials: RD
authors.lastname: de Sousa
authors.affiliation: NOVA Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Pedro S
authors.identifier: http://orcid.org/0000-0003-0828-9956
authors.initials: PS
authors.lastname: Coelho
authors.affiliation: NOVA Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Jorge M
authors.identifier: http://orcid.org/0000-0003-2251-3803
authors.initials: JM
authors.lastname: Mendes
authors.affiliation: Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.|Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisboa, Portugal.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0002-6262-4658
authors.initials: P
authors.lastname: Graça
authors.affiliation: Católica-Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0001-6733-0846
authors.initials: P
authors.lastname: Oliveira
authors.affiliation: EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.|Serviço de Reumatologia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Jaime C
authors.identifier: http://orcid.org/0000-0001-7024-4375
authors.initials: JC
authors.lastname: Branco
authors.affiliation: EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.|Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.
authors.forename: Helena
authors.identifier: http://orcid.org/0000-0003-1894-4870
authors.initials: H
authors.lastname: Canhão
keywords: TV app; food insecurity; healthy lifestyle promotion; information and communication technology; new technologies