A computer-tailored dietary fat intake intervention for adolescents: results of a randomized controlled trial

Effects of computer-based interventions on food consumption and anthropometric parameters of adolescents: A systematic review and metanalysis

This review aimed to systematically assess the effects of computer-based interventions for the promotion of healthy eating on anthropometric indicators and food consumption of adolescents at school. Relevant scientific articles were searched in MEDLINE/PubMed, Embase, Scopus, Lilacs, PsycINFO and Cochrane Library/CENTRAL following the recommendations by PRISMA guide in August 2021. The quality and risk of bias in the studies were assessed by two reviewers independently. The search strategy retained 13 studies for qualitative analysis. In total 9.603 adolescents of both sexes, were recruited in a school environment. According to studies with information for the meta-analysis, a reduction in the average consumption of fats in favor of computer-based intervention was identified (SMD: -0.14; 95% CI -0.24;-0.05). Considering the changes in the consumption of fruits and vegetables (SMD: 0.09; 95% CI -0.08; 0.26) and in the BMI (WMD: -0.02; 95% CI -0.18; 0.14), the analyses did not identify the effect of computer-based interventions on these parameters after follow-up. The results of this review demonstrate that there is evidence of the positive effect of using digital technology (website and CD-ROM) in educational programs with a focus on promoting a healthy lifestyle, with evidence on reducing fat consumption.

What makes interventions aimed at improving dietary behaviours successful in the secondary school environment? A systematic review of systematic reviews

OBJECTIVE

To systematically review evidence from systematic reviews of interventions to improve dietary behaviours and reduce food wastage in secondary school pupils.

DESIGN

CINAHL, Cochrane Reviews, EMBASE, MEDLINE, PsychINFO and Web of Science were searched for systematic reviews of school-based dietary interventions from 2000 to 2020 published in a peer-reviewed journal in English. Articles were reviewed independently by two authors. AMSTAR-2 was used for quality assessment.

SETTING

Secondary school dietary interventions.

PARTICIPANTS

Adolescents (aged 11-18).

RESULTS

In total, thirteen systematic reviews of dietary interventions in secondary schools met the inclusion criteria. A number of key characteristics of interventions that contributed to improvements in food choices in secondary school pupils were identified. These included the combination of education and environmental restructuring, incorporation of computer-based feedback, media or messaging, peer and/or parent involvement, an increase in the availability of healthy foods and the use of behavioural theory as a basis to the intervention. Intervention components that contributed specifically to a reduction in sugar-sweetened beverage intake or an increase in fruit and vegetable consumption, which are particularly relevant to adolescents, could not be determined. Similarly, evidence for interventions that improve nutritional knowledge and attitudes was limited.

CONCLUSIONS

This systematic review of systematic reviews has identified a number of components of dietary interventions that can be explored to improve dietary behaviours in secondary school environments and, if demonstrated to be effective, be considered for inclusion in policies and strategies to improve the school food environment and promote dietary change.

Digital Interventions for Universal Health Promotion in Children and Adolescents: A Systematic Review

BACKGROUND AND OBJECTIVES

Digital media has been used mostly to deliver clinical treatments and therapies; however limited evidence evaluates digital interventions for health promotion. The objective of this review is to identify digital interventions for universal health promotion in school-aged children and adolescents globally.

METHODS

Eligible articles were searched in PubMed, Embase, Medline, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, WHO regional databases, Google Scholar, and reference lists from 2000 to March 2021. Randomized controlled trials and quasi-experimental studies evaluating interventions that promote health in school-aged children and adolescents (5-19.9 years) were included. Methods were conducted in duplicate. Where possible, data were pooled with a random-effects model.

RESULTS

Seventy-four studies were included (46 998 participants), of which 37 were meta-analyzed (19 312 participants). Interventions increased fruit and vegetable consumption (servings per day) (mean difference [MD] 0.63, 95% confidence interval [CI] 0.21 to 1.04; studies = 6; P = .003; high quality of evidence), and probably reduced sedentary behavior (MD -19.62, 95% CI -36.60 to -2.65; studies = 6; P = .02; moderate quality of evidence), and body fat percentage (MD -0.35%, 95% CI -0.63 to -0.06; studies = 5; P = .02; low quality of evidence). The majority of studies were conducted in high-income countries and significant heterogeneity in design and methodology limit generalizability of results.

CONCLUSIONS

There is great potential in digital platforms for universal health promotion; however, more robust methods and study designs are necessitated. Continued research should assess factors that limit research and program implementation in low- to middle-income countries.

The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity

Background

Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children.

Objective

The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P.

Methods

This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake).

Results

The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70%). Overall, 95% of the children liked the game very much or much. No group changes were observed at the behavioral level.

Conclusions

The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P.

Trial Registration

ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978

Pilot evaluation of an interactive multimedia platform to provide nutrition education to Portuguese adolescents

Background

Obesity prevalence has been rising worldwide and currently is one of the most serious public health problems. Nutrition literacy is important to the development of healthier habits that could help prevent and stem obesity and overweight. The aim of this study was to evaluate the impact of using a multimedia web platform to provide nutrition education to Portuguese adolescents.

Methods

The intervention consisted in a two-week period in which students (n = 1291) had access to an interactive multimedia web platform with nutritional content, and designed for a self-paced learning experience. Students completed a knowledge questionnaire at baseline and immediately after the end of the intervention.

Results

The results obtained revealed that 85.8% of the students increased their nutrition knowledge. No gender differences were observed post-intervention. There were significant differences in the knowledge acquisition regarding age (P &lt; 0.001). The baseline knowledge seemed to influence the learning process.

Conclusions

Overall, the intervention had a positive impact. The preliminary results observed will be important for the improvement of the intervention, though they need to be confirmed by further research. Nevertheless, it is safe to say that technology-based assets can be important tools to incorporate and complement health-related interventions in schools.

The effect of Public Health/Pediatric Obesity interventions on socioeconomic inequalities in childhood obesity: A scoping review

Childhood obesity has a strong social gradient. This scoping review aims to synthesize the evidence on the impact on inequalities of non-targeted interventions to reduce the prevalence of childhood and adolescent obesity in high-income countries. We updated a review by Hillier-Brown, searching up to 31 December 2017 on MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO, with no limitations on study design. Fifty-eight studies describing 51 interventions were included: 31 randomized clinical trials and 27 non-randomized trials, with sample sizes from 67 to 2,700,880 subjects. The majority were implemented in the school setting at a community level; the others were in health services or general population setting and targeting individuals or the system. Twenty-nine interventions proved to be effective overall; seven others had an effect only in a subgroup, while 15 proved not to be effective. All types of included interventions can increase inequalities. Moreover, some interventions had opposite effects based on the socioeconomic characteristics. Any kind of intervention can reduce equity. Consequences are difficult to predict based on intervention construct. Complex interventions acting on multiple targets, settings, and risk factors are more effective and have a lower risk of increasing inequalities.

Evaluation of the Computer-Based Intervention Program Stayingfit Brazil to Promote Healthy Eating Habits: The Results from a School Cluster-Randomized Controlled Trial

Interventions via the Internet are promising regarding the promotion of healthy habits among youth. The objective of this study was to evaluate the effect of an adapted version of StayingFit to promote healthy eating habits and the measurement adequacy of anthropometric markers among adolescents. A web school-based 12-month cluster-randomized controlled trial examining 7th to 9th grade students was conducted in twelve schools in Salvador, Bahia, Brazil. The schools' students were randomly distributed into the intervention and control groups. The intervention group participated in StayingFit, an online program designed to encourage and guide healthy eating habits and control body weight. Data on food consumption, anthropometry, physical activity level, and sedentary behavior were collected from all of the students at the beginning of and after the 12-month study. Demographic and socioeconomic data were collected at baseline. The baseline data indicated high rates of overweight (14.4% overweight and 8.5% obese), insufficiently active (87.6%), and sedentary (63.7%). Furthermore, few adolescents regularly consumed fruits (18.8%) and vegetables/legumes (16.4%). Generalized estimating equations (GEEs) were used to evaluate the effect of the intervention. At the end of the follow-up period, students in the intervention group had a 43% increased chance of regularly consuming beans (OR = 1.43, 95% CIs = 1.10-1.86) and a 35% decreased chance of regularly consuming soft drinks (OR = 0.65, 95% CIs = 0.50-0.84). No differences were found between the groups studied with regard to the anthropometric parameters. Despite these modest results, the implementation of a web intervention can be beneficial and help promote positive changes in adolescent eating habits.

Tailored Educational Approaches for Consumer Health: A Model to Address Health Promotion in an Era of Personalized Medicine

PURPOSE

To develop a model, based on market segmentation, to improve the quality and efficiency of health promotion materials and programs.

DESIGN

Market segmentation to create segments (groups) based on a cross-sectional questionnaire measuring individual characteristics and preferences for health information. Educational and delivery recommendations developed for each group.

SETTING

General population of adults in Virginia.

PARTICIPANTS

Random sample of 1201 Virginia residents. Respondents are representative of the general population with the exception of older age.

MEASURES

Multiple factors known to impact health promotion including health status, health system utilization, health literacy, Internet use, learning styles, and preferences.

ANALYSIS

Cluster analysis and discriminate analysis to create and validate segments. Common sized means to compare factors across segments.

RESULTS

Developed educational and delivery recommendations matched to the 8 distinct segments. For example, the "health challenged and hard to reach" are older, lower literacy, and not likely to seek out health information. Their educational and delivery recommendations include a sixth-grade reading level, delivery through a provider, and using a "push" strategy.

CONCLUSION

This model addresses a need to improve the efficiency and quality of health promotion efforts in an era of personalized medicine. It demonstrates that there are distinct groups with clearly defined educational and delivery recommendations. Health promotion professionals can consider Tailored Educational Approaches for Consumer Health to develop and deliver tailored materials to encourage behavior change.

Nutritional interventions for adolescents using information and communication technologies (ICTs): A systematic review

A cost-effective and interactive way of promoting healthy nutrition behaviors among adolescents is using information and communication technologies (ICTs). We systematically reviewed studies to identify technologies and their main characteristics used for nutritional interventions for adolescents, as well as to evaluate their quality and effectiveness. Our full protocol is available on the PROSPERO website (#CRD42016035882). A search was conducted across five databases for articles describing nutritional interventions that used ICTs designed mainly for healthy adolescents. Randomized controlled trials, quasi-experimental and observational studies, and full and original papers, all of them published from 2005 to 2015, were included. Study quality was assessed by the Effective Public Health Practice Project Quality Assessment Tool. Our search yielded 559 titles and abstracts. Eleven studies met the inclusion criteria. Participants were recruited mostly from schools. Study follow-up ranged from two weeks to two years. Four interventions were based on the Social Cognitive Theory. Interventional strategies included computer games, programs, text messages, and interactive CD-ROMs. Nine studies used computer-mediated ICTs. Five studies focused on multiple behaviors simultaneously. Participants were exposed to interventions only once, daily, weekly, or according to a pre-determined number of lessons. Five studies had significant outcomes. Our quality assessment revealed three studies to be weak due to non-representativeness of their samples and usage of non-validated questionnaires. Besides the heterogeneity and poor quality of the analyzed studies, it can be suggested that long-term interventions for adolescents that make use of frequent exposure to technological resources, and that have a theoretical component aimed at a single health behavior change, tend to be more successful.

Chances and Limitations of Video Games in the Fight against Childhood Obesity-A Systematic Review

OBJECTIVE AND METHOD

A systematic literature search was conducted to assess the chances and limitations of video games to combat and prevent childhood obesity. This search included studies with video or computer games targeting nutrition, physical activity and obesity for children between 7 and 15 years of age.

RESULTS

The study distinguished between games that aimed to (i) improve knowledge about nutrition, eating habits and exercise; (ii) increase physical activity; or (iii) combine both approaches. Overall, the games were well accepted. On a qualitative level, most studies reported positive effects on obesity-related outcomes (improvement of weight-related parameters, physical activity or dietary behaviour/knowledge). However, the observed effects were small. The games did not address psychosocial aspects.

CONCLUSIONS

Using video games for weight management exclusively does not deliver satisfying results. Video games as an additional guided component of prevention and treatment programs have the potential to increase compliance and thus enhance treatment outcome. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Behavioural effects of a community-oriented setting-based intervention for prevention of childhood obesity in eight European countries. Main results from the IDEFICS study

OBJECTIVE

The objective of this paper is to evaluate the behavioural effects, as reported by the parents of the participating boys and girls, of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) intervention.

METHODS

The effectiveness of the IDEFICS intervention was evaluated through a cluster-controlled trial in eight European countries (control and intervention communities in each country) including more than 16,000 children. The 2- to 9.9-year-old children in the intervention group were exposed to a culturally adapted intervention that aimed to prevent childhood obesity through the community, schools/kindergartens and family. Parents completed questionnaires to measure water, soft drink and fruit juice intake; fruit and vegetable intake; daily TV viewing and other sedentary behaviours; daily physical activity levels and strengthening of the parent-child relationships at baseline and follow-up (2 years later). Mixed models with an additional random effect for country were used to account for the clustered study design, and results were stratified by sex.

RESULTS

The pan-European analysis revealed no significant time by condition interaction effects, neither for boys nor girls, i.e. the analysis revealed no intervention effects on the behaviours of the IDEFICS children as reported by their parents (F = 0.0 to 3.3, all p > 0.05). Also very few significances were found in the country-specific analyses. Positive intervention effects were only found for sport club participation in Swedish boys, for screen time in weekends for Spanish boys and for TV viewing in Belgian girls.

CONCLUSION

Although no expected intervention effects as reported by the parents on diet, physical activity and sedentary behaviours could be shown for the overall IDEFICS cohort, a few favourable intervention effects were found on specific behaviours in some individual countries. More in-depth analyses of the process evaluation data are needed to obtain more insight into the relationship between the level of exposure to the intervention and its effect.

Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact

BACKGROUND

Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. It is not known whether healthy eating interventions are equally effective among all sections of the population, nor whether they narrow or widen the health gap between rich and poor. We undertook a systematic review of interventions to promote healthy eating to identify whether impacts differ by socioeconomic position (SEP).

METHODS

We searched five bibliographic databases using a pre-piloted search strategy. Retrieved articles were screened independently by two reviewers. Healthier diets were defined as the reduced intake of salt, sugar, trans-fats, saturated fat, total fat, or total calories, or increased consumption of fruit, vegetables and wholegrain. Studies were only included if quantitative results were presented by a measure of SEP. Extracted data were categorised with a modified version of the "4Ps" marketing mix, expanded to 6 "Ps": "Price, Place, Product, Prescriptive, Promotion, and Person".

RESULTS

Our search identified 31,887 articles. Following screening, 36 studies were included: 18 "Price" interventions, 6 "Place" interventions, 1 "Product" intervention, zero "Prescriptive" interventions, 4 "Promotion" interventions, and 18 "Person" interventions. "Price" interventions were most effective in groups with lower SEP, and may therefore appear likely to reduce inequalities. All interventions that combined taxes and subsidies consistently decreased inequalities. Conversely, interventions categorised as "Person" had a greater impact with increasing SEP, and may therefore appear likely to reduce inequalities. All four dietary counselling interventions appear likely to widen inequalities. We did not find any "Prescriptive" interventions and only one "Product" intervention that presented differential results and had no impact by SEP. More "Place" interventions were identified and none of these interventions were judged as likely to widen inequalities.

CONCLUSIONS

Interventions categorised by a "6 Ps" framework show differential effects on healthy eating outcomes by SEP. "Upstream" interventions categorised as "Price" appeared to decrease inequalities, and "downstream" "Person" interventions, especially dietary counselling seemed to increase inequalities. However the vast majority of studies identified did not explore differential effects by SEP. Interventions aimed at improving population health should be routinely evaluated for differential socioeconomic impact.

Impact of computer-mediated, obesity-related nutrition education interventions for adolescents: a systematic review

PURPOSE

The purpose of this systematic review was to evaluate recent research regarding the use of computer-based nutrition education interventions targeting adolescent overweight and obesity.

METHODS

Online databases were systematically searched using key words, and bibliographies of related articles were manually searched. Inclusion/exclusion criteria were applied and included studies evaluated for their ability to achieve their objectives and for quality using the Nutrition Evidence Library appraisal guidelines for research design and implementation.

RESULTS

Of the 15 studies included, 10 were randomized controlled trials. Two studies targeted weight loss, 2 targeted weight maintenance, and 11 targeted dietary improvement with or without physical activity. At least half of in-school (60%) and nonschool interventions (80%) exhibited significantly positive effects on nutrition- or obesity-related variables. Small changes in diet, physical activity, knowledge, and self-efficacy were shown; however, few results were sustained long term.

CONCLUSIONS

Recommendations included application of health behavior theory and computer tailoring for feedback messages. Future research should include thorough description of intervention content (messages, theory, multimedia, etc.), application of rigorous methodology, as well as consideration of covariates such as parental involvement and gender. With further research and evidentiary support, this approach to obesity-related nutrition education has the potential to be successful.

Moderators of the effectiveness of a web-based tailored intervention promoting physical activity in adolescents: the HELENA Activ-O-Meter

BACKGROUND

The aim of this study was to examine the moderation effects of sex, age, and psychosocial determinants (intention, social support, and modeling) of physical activity (PA) in the relationship between an Internet-based computer-tailored intervention program (Activ-O-Meter) and modes of PA and commuting.

METHODS

The Activ-O-Meter with intervention and control condition was delivered to 555 adolescents (boys 50.5%, mean age: 14.4 years) in 6 European cities. Data on different modes of PA and commuting, sex, age, and psychosocial determinants were collected at baseline and at 3-months follow-up, using questionnaires. The moderation effects of psychosocial determinants, sex, and age on the association between condition and modes of PA and commuting were tested with linear regression.

RESULTS

Moderation analysis showed that the following increased adolescents' responsiveness to the intervention: male sex, older age, higher baseline intention to increase PA, higher perceived social support or modeling level by siblings, and low perceived social support by friends.

CONCLUSIONS

These findings should be taken into consideration when planning PA interventions in adolescents. Future intervention studies should also include moderation analysis in order to get a deeper understanding of why interventions are not effective for certain individuals and how this unresponsiveness could be overcome.

Implementation of a school-based internet obesity prevention program for adolescents

OBJECTIVE

To evaluate the reach, adoption, and implementation of HEALTH[e]TEEN, a school-based Internet obesity prevention program, and examine differences in student participation and satisfaction by school, gender, age, and race/ethnicity.

DESIGN

Concurrent mixed method evaluation.

SETTING

Three public high schools in Connecticut.

PARTICIPANTS

Three hundred eighty-four adolescents, 8 teachers.

INTERVENTION(S)

HEALTH[e]TEEN vs HEALTH[e]TEEN plus coping skills training.

MAIN OUTCOME MEASURE(S)

Demographic and state-available data, measurements of student satisfaction and participation, interviews with school administrators and teachers.

ANALYSIS

Mixed and logistic models, content analysis.

RESULTS

The sample (n = 384) was diverse (35% white), with a mean age of 15.3 years and mean body mass index of 24.7 kg/m(2). Student participation (83% of lessons completed) and satisfaction (mean 3.6 out of 5) was high. Schools implementing the program in class had higher satisfaction and participation compared with schools that implemented the program as homework (P ≤ .001 and < .001, respectively). Girls had higher satisfaction and participation compared with boys (P = .02 and .03, respectively). Younger students had higher participation compared with older students, but no difference in satisfaction was noted (P = .03).

CONCLUSIONS AND IMPLICATIONS

Two school-based Internet programs to decrease obesity reached diverse adolescents, and were adopted and implemented with high student satisfaction and participation. Implementation of the intervention was influenced by setting (classroom vs homework), teacher characteristics, student age, and gender.

Evaluation of a web-based program promoting healthy eating and physical activity for adolescents: teen choice: food and fitness

This randomized clinical trial tested the impact of a website promoting nutrition and physical activity for adolescents (Teen Choice: Food and Fitness). Participants, (408) 12- to 17-year-old adolescents in the Houston area, completed online surveys measuring diet, physical activity, sedentary behavior and diet/physical activity mediators at baseline. After randomization, they were asked to log onto either the intervention or the control condition website weekly for 8 weeks to review web content and set goals to improve dietary and physical activity behaviors. Post-test occurred after 8 weeks. Logistic regression analyses and one-way analyses of covariance were used in the analyses. At post, more intervention group adolescents reported eating three or more daily vegetable servings in the past week compared with the control group (P < 0.05); both groups reported significant increases in physical activity (P < 0.001) and significant decreases in TV watching (P < 0.01). Average log on rate was 75% over the 8 weeks; there was no difference by condition. The website enabled adolescents to improve vegetable intake and daily physical activity, reduce sedentary behavior and had a high log on rate. Future research should identify effective methods for disseminating this website to wider audiences.

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students

This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.

Formative evaluation of the feedback component of Children's and Adolescents’ Nutrition Assessment and Advice on the Web (CANAA-W) among parents of schoolchildren

Objective

The aim of the paper is to describe the formative evaluation of the feedback component of an online nutrition tailoring instrument, the Children's and Adolescents’ Nutrition Assessment and Advice on the Web (CANAA-W), among parents of schoolchildren.

Design

Parents of pre-primary and primary-school children recorded their child's food intake over 3 d with CANAA-W and completed the evaluation questionnaire online. A subsample participated in focus group discussions.

Setting

Parents completed CANAA-W at home.

Subjects

Forty-six parents completed the evaluation questionnaire. Seventeen parents participated in three focus group discussions.

Results

Parents were enthusiastic: the majority (81 % or more) found the advice comprehensible, interesting, logical, useful, believable, well formulated, correct, personal, relevant, complete, attractive, containing enough and not too much information; they indicated that it is helpful to improve their children's eating habits and that they intend to use it. The qualitative analyses revealed that the respondents appreciated the confrontation with their child's diet and the visualization (i.e. traffic light colours, pictograms, food models, diagrams). The length of the feedback was rather a drawback, but it was useful nevertheless.

Conclusions

CANAA-W was well received by the parents; the scores on the feasibility questionnaire were high and the qualitative analyses showed that the confrontation with their child's diet, and attractive visualization of the most relevant feedback linked to more elaborated optional feedback, were well appreciated. The major challenge will be to convince parents who are less interested in food habits and less computer-literate to participate in this type of study.

What is the role and authority of gatekeepers in cluster randomized trials in health research?

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the CRT is to be set on a firm ethical foundation. This paper addresses the sixth of the questions posed, namely, what is the role and authority of gatekeepers in CRTs in health research? ‘Gatekeepers’ are individuals or bodies that represent the interests of cluster members, clusters, or organizations. The need for gatekeepers arose in response to the difficulties in obtaining informed consent because of cluster randomization, cluster-level interventions, and cluster size. In this paper, we call for a more restrictive understanding of the role and authority of gatekeepers.

Previous papers in this series have provided solutions to the challenges posed by informed consent in CRTs without the need to invoke gatekeepers. We considered that consent to randomization is not required when cluster members are approached for consent at the earliest opportunity and before any study interventions or data-collection procedures have started. Further, when cluster-level interventions or cluster size means that obtaining informed consent is not possible, a waiver of consent may be appropriate. In this paper, we suggest that the role of gatekeepers in protecting individual interests in CRTs should be limited. Generally, gatekeepers do not have the authority to provide proxy consent for cluster members. When a municipality or other community has a legitimate political authority that is empowered to make such decisions, cluster permission may be appropriate; however, gatekeepers may usefully protect cluster interests in other ways. Cluster consultation may ensure that the CRT addresses local health needs, and is conducted in accord with local values and customs. Gatekeepers may also play an important role in protecting the interests of organizations, such as hospitals, nursing homes, general practices, and schools. In these settings, permission to access the organization relies on resource implications and adherence to institutional policies.

Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review

AIMS

To: (1) determine the effect of computer- and web-based interventions on improving eating behavior (e.g. increasing fruit and vegetable consumption; decreasing fat consumption) and/or diet-related physical outcomes (e.g. body mass index) among children and adolescents; and (2) examine what elements enhance success.

BACKGROUND

Children and adolescents are the heaviest they have ever been. Excess weight can carry into adulthood and result in chronic health problems. Because of the capacity to reach large audiences of children and adolescents to promote healthy eating, computer- and web-based interventions hold promise for helping to curb this serious trend. However, evidence to support this approach is lacking.

DESIGN

Systematic review using guidelines from the Cochrane Effective Practice and Organisation of Care Group.

DATA SOURCES

The following databases were searched for studies from 1998-2011: CINAHL; PubMed; Cochrane; PsycINFO; ERIC; and Proquest.

REVIEW METHODS

Fifteen randomized controlled trials or quasi-experimental studies were analysed in a systematic review.

RESULTS

Although a majority of interventions resulted in statistically significant positive changes in eating behavior and/or diet-related physical outcomes, interventions that included post intervention follow-up, ranging from 3-18 months, showed that changes were not maintained. Elements, such as conducting the intervention at school or using individually tailored feedback, may enhance success.

CONCLUSION

Computer- and web-based interventions can improve eating behavior and diet-related physical outcomes among children and adolescents, particularly when conducted in schools and individually tailored. These interventions can complement and support nursing efforts to give preventive care; however, maintenance efforts are recommended.

Design of a website on nutrition and physical activity for adolescents: results from formative research

Background

Teens do not meet guidelines for healthy eating and physical activity. The Internet may be an effective method for delivering programs that help them adopt healthy behaviors.

Objective

To collect information to design content and structure for a teen-friendly website promoting healthy eating and physical activity behaviors.

Methods

Qualitative research, encompassing both focus group and interview techniques, were used to design the website. Participants were 12-17 year olds in Houston, Texas, and West Lafayette, Indiana.

Results

A total of 133 participants took part in 26 focus groups while 15 participated in one-on-one interviews to provide guidance for the development of teen-friendly content and structure for an online behavior change program promoting healthy eating and physical activity to 12-17 year olds. The youth made suggestions to overcome common barriers to healthy eating and physical activity. Their feedback was used to develop “Teen Choice: Food & Fitness,” a 12-week online behavior change program, populated by 4 cartoon character role models.

Conclusions

It is critical that members of the target audience be included in formative research to develop behavior change programs that are relevant, appealing, and address their needs and interests.

Reporting standards for studies of tailored interventions

Message tailoring is a promising innovative approach to persuasive communication that involves designing messages to meet a person's psychological, behavioral and/or demographic characteristics. Although the tailored intervention literature has many strengths, a weakness is inconsistency in reporting information related to intervention development, implementation and evaluation. The objective of this manuscript is to report recommendations for studies of tailored interventions. As part of ongoing original empirical and meta-analytical research, we reviewed the tailoring literature and identified inconsistencies in reporting. We compared these inconsistencies with existing reporting standards and developed recommendations specific to tailored interventions. An advisory board of preeminent tailoring researchers provided feedback on draft and final recommendations. This paper offers the resulting seven recommendations for reporting studies of tailored interventions. If we are to build a cumulative science of tailoring, both for theory development and research translation, then we should establish standards in the conduct and reporting of the science.

For whom and under what circumstances do school-based energy balance behavior interventions work? Systematic review on moderators

The aim of this review was to systematically review the results and quality of studies investigating the moderators of school-based interventions aimed at energy balance-related behaviors. We systematically searched the electronic databases of Pubmed, EMBASE, Cochrane, PsycInfo, ERIC and Sportdiscus. In total 61 articles were included. Gender, ethnicity, age, baseline values of outcomes, initial weight status and socioeconomic status were the most frequently studied potential moderators. The moderator with the most convincing evidence was gender. School-based interventions appear to work better for girls than for boys. Due to the inconsistent results, many studies reporting non-significant moderating effects, and the moderate methodological quality of most studies, no further consistent results were found. Consequently, there is lack of insight into what interventions work for whom. Future studies should apply stronger methodology to test moderating effects of important potential target group segmentations.

Optimizing Tailored Health Communications

This review discusses evidence-based perspectives on tailored health communications for lifestyle modification. Future directions for inquiry and practice also are addressed.

Pilot evaluation of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Food-O-Meter, a computer-tailored nutrition advice for adolescents: a study in six European cities

OBJECTIVE

To investigate the feasibility and impact of the Food-O-Meter, an Internet-based computer-tailored nutrition intervention in adolescents.

DESIGN

Participants in the intervention condition received the computer-tailored advice at baseline and at 1 month, those in the control condition received standardised advice. Effects were evaluated at 1 month (n 621) and at 3 months (n 558) using multi-level modelling.

SETTING

Secondary schools in six European cities. Adolescents accessed the intervention in the school computer room under the supervision of teachers.

SUBJECTS

Classes with students aged 12-17 years in the schools participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study were randomised into intervention and control schools.

RESULTS

In most participating centres the intervention was feasible and generally well appreciated, especially by girls. Technical problems and lack of motivation of the teachers hindered implementation in some centres. Overweight adolescents had higher scores for reading and using the advice than normal weight adolescents. After 1 month adolescents receiving the standardised advice reported an increase in fat intake, while fat intake in the intervention condition was stable (F = 4·82, P < 0·05). After 3 months, there was a trend in the total group for an intervention effect of the tailored advice on fat intake (F = 2·80, P < 0·10). In the overweight group there was a clear positive effect (F = 5·76, P < 0·05).

CONCLUSIONS

The Food-O-Meter should be developed further. The results were modest but clear for percentage energy from fat, specifically in the overweight group. Adaptations based on new research are needed to enhance the reliability and effectiveness of the intervention.

A meta-analysis of computer-tailored interventions for health behavior change

OBJECTIVE

Computer-tailored interventions have become increasingly common for facilitating improvement in behaviors related to chronic disease and health promotion. A sufficient number of outcome studies from these interventions are now available to facilitate the quantitative analysis of effect sizes, permitting moderator analyses that were not possible with previous systematic reviews.

METHOD

The present study employs meta-analytic techniques to assess the mean effect for 88 computer-tailored interventions published between 1988 and 2009 focusing on four health behaviors: smoking cessation, physical activity, eating a healthy diet, and receiving regular mammography screening. Effect sizes were calculated using Hedges g. Study, tailoring, and demographic moderators were examined by analyzing between-group variance and meta-regression.

RESULTS

Clinically and statistically significant overall effect sizes were found across each of the four behaviors. While effect sizes decreased after intervention completion, dynamically tailored interventions were found to have increased efficacy over time as compared with tailored interventions based on one assessment only. Study effects did not differ across communication channels nor decline when up to three behaviors were identified for intervention simultaneously.

CONCLUSION

This study demonstrates that computer-tailored interventions have the potential to improve health behaviors and suggests strategies that may lead to greater effectiveness of these techniques.

Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and ‘grey’ literature

The objective of the present review was to summarise the existing European published and ‘grey’ literature on the effectiveness of school-based interventions to promote a healthy diet in children (6–12 years old) and adolescents (13–18 years old). Eight electronic databases, websites and contents of key journals were systematically searched, reference lists were screened, and authors and experts in the field were contacted for studies evaluating school-based interventions promoting a healthy diet and aiming at primary prevention of obesity. The studies were included if they were published between 1 January 1990 and 31 December 2007 and reported effects on dietary behaviour or on anthropometrics. Finally, forty-two studies met the inclusion criteria: twenty-nine in children and thirteen in adolescents. In children, strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes. Limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. In adolescents, moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In children and adolescents, effects on anthropometrics were often not measured, and therefore evidence was lacking or delivered inconclusive evidence. To conclude, evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet in school-aged children in European Union countries on self-reported dietary behaviour. Evidence for effectiveness on anthropometrical obesity-related measures is lacking.

Motivation, self-efficacy, physical activity and nutrition in college students: randomized controlled trial of an internet-based education program

OBJECTIVE

MyStudentBody.com-Nutrition (MSB-N) is an internet-based nutrition and physical activity education program for college students.

METHOD

Students from six universities (N=476) in the U.S. were randomly assigned in the fall of 2005 to one of three groups: MSB-N (Experimental I), MSB-N plus Booster (Experimental II), or an attention placebo control group.

RESULTS

Experimental I and II group participants increased their fruit and vegetable intake by .33 and .24 servings, respectively, relative to the control group at post-test. Both experimental groups improved their motivation to change eating behaviors (p<.05) and were also more likely to increase their social support and self-efficacy for dietary change (p's<.05). Experimental groups also improved their attitude toward exercise (p<.05), but no behavioral changes in physical activity were noted.

CONCLUSION

MyStudentBody.com-Nutrition is an effective internet-based program that may have wide applicability on college campuses for nutrition education and promoting change in health behaviors.