A comparison of Web and print media for physical activity promotion among adolescent girls

Communicating physical activity messages with adolescents: what works? A scoping review with stakeholder consultation

BACKGROUND

Global levels of adolescents' physical inactivity are cause for concern, despite the well-documented health benefits of physical activity (PA). Addressing the messaging of PA is one approach to improve PA knowledge. While increased knowledge does not necessarily lead to behavior change, physically active students have better knowledge of the health benefits of PA. Recently, researchers have highlighted the need for an effective communication strategy for PA messages. This review aimed to summarize the state of the available evidence about the operationalization of communicating PA messages, the evaluation, and effectiveness of PA messages.

METHODS

The Levac six steps and Joanna Briggs Institute methodological guidance for scoping reviews were followed. Five databases were searched up until April 8th 2024. Both title and abstract and full-text screening were piloted whereby 10% of the total articles were double-screened and the remainder were completed by CG. Data were extracted and a data-based convergent synthesis design was used following qualitative synthesis methods. Finally, a consultation with key stakeholders was held to confirm the findings concerning practical relevance.

RESULTS

A total of 19,412 articles were identified from searches, 94 full texts were included in the final analysis, corresponding to 80 individual studies. The evidence confirms that there are many factors to consider when communicating PA messages and evaluating their effectiveness. Inconsistencies exist regarding the timing and frequency of message delivery and the evaluation of effective communication. When communicating PA with adolescents, messages commonly focus on the benefits of PA and strategies to overcome barriers and are commonly delivered in the school setting by researchers or school stakeholders i.e. teachers, peers. Messages should be concise, positively framed, support adolescent autonomy, and utilize different messaging platforms and techniques to avoid staleness.

CONCLUSIONS

There is a lack of a standardized approach to communicating PA messages with adolescents making evaluation and comparison challenging. Future research should focus on developing guidance to facilitate the effective communication of PA messages with adolescents.

Print Media Role and Its Impact on Public Health: A Narrative Review

Print media plays a pivotal role in communicating public health information, acting as a vital channel for spreading awareness and encouraging healthy behaviors. This narrative review delves into the historical significance of print media in health communication while evaluating its relevance in today's digital media environment. Despite encountering significant hurdles like digital competition and financial limitations, print media remains indispensable for addressing crucial health issues and disseminating information during public health emergencies. Effectively utilizing print media for health promotion necessitates careful planning, thorough evaluation, and targeted distribution to ensure widespread impact and audience engagement. Employing a comprehensive search strategy, relevant literature was identified through electronic databases and manual searches of reference lists. The gathered literature underwent rigorous screening to align with the review's objectives, with key insights synthesized through iterative analysis. Print media remains a cornerstone of health communication, offering tangible avenues for information dissemination and audience interaction. However, its efficacy is subject to various factors, including technological advancements, evolving media landscapes, and challenges in content dissemination. Overcoming these obstacles requires innovative approaches and collaborative endeavors to harness the full potential of print media in advancing public health objectives.

Resistance to Masks During the COVID-19 Pandemic: How User Comments Drive Psychological Reactance to Health Campaigns

Campaigns for mask-wearing have become widespread on digital platforms during the COVID-19 outbreak and have garnered varied responses in the form of comments. The present study conducts a 2 (comment position: pro-mask wearing vs. anti-mask wearing) × 2 (comment tone: civil vs. uncivil) between-subjects experiment to investigate whether and how the position and tone of comments accompanying a health campaign on social media affect people's psychological reactance toward the campaign. The results show that although anti-mask wearing comments following a social media mask-promoting post provoke individuals' perception about others' disapproval of the post, the perception did not trigger the individuals' psychological reactance to the post. Nevertheless, uncivil comments elicit anger, which arouses reactance and cause persuasion failure.

Print Materials to Promote Physical Activities in Japan: Content Analysis from a Goal Theory

Physical activity has significant health benefits for the heart, body, and mind. However, the percentage of people engaging in exercise routines is low in Japan. Goals are important components of motivation. Scholars suggest that appropriately setting both subordinate goals of what to do and superordinate goals of why to do it may motivate the audience and promote behavior. However, it is not known what goals are presented in print materials that promote physical activity. Therefore, this study aimed to understand the presented goals by performing content analysis of those materials in Japan. We collected print materials such as leaflets, brochures, and posters via website search. The presence of subordinate and superordinate goals and topics for each goal was analyzed. A total of 224 print materials were systematically collected and analyzed. The results showed that 14.3% of the print materials did not present any superordinate goals, whereas 100% of them presented subordinate goals. For superordinate goals, healthy aging was frequently presented. For subordinate goals, 67.4% presented only exercise. There is a difference in presenting goals between the private and government sectors. Since goals affect motivation and behavior change, it may be beneficial to incorporate the findings of the goal theory in future print materials.

Can internet use change sport participation behavior among residents? Evidence from the 2017 Chinese General Social Survey

Purpose

The popularization of the internet has promoted the implementation of China's national fitness strategy and created conditions for Chinese residents to participate in sports. The internet is an essential medium for disseminating sports knowledge, and the use of the internet can change sport participation behaviors. Therefore, the internet can be used to popularize sports knowledge and promote the participation of all people in sports and thus improve the health of the entire population. This study attempts to empirically analyse how the use of the internet changes sport participation behavior.

Method

Utilizing data from the 2017 China General Social Survey, a probit model, ivprobit model, and bias-corrected non-parametric percentile bootstrap test were used to analyse the impact of internet use on sport participation behavior.

Results

The empirical results show that internet use significantly increased the probability of participation in sports by Chinese residents. Heterogeneity test results showed that internet use was more effective in promoting sport participation in middle-aged groups, groups of older persons, unmarried groups, and groups with a high school education or above. The mediating effect test results showed that internet use influenced residents' participation in sports by promoting social interaction, leisure and entertainment, and learning and recharging.

Conclusions

The internet has changed participation in sports; specifically, the use of the internet promotes sport participation. Additionally, internet use has a more obvious impact on improving the sport participation behavior of middle-aged, older, unmarried, and middle- and higher-educated individuals. Internet social interaction, internet entertainment and internet learning are effective channels to encourage Chinese residents to participate in sports and improve their health.

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 Effects of Two Community-Based Participatory Action Research Programs on Violence Outside of and in School Among Adolescents and Young Adults in a Latino Community

PURPOSE

Violence is the leading cause of death among adolescents and young adults in the Americas. Community-Based Participatory Action Research engaged youth and parents to develop and implement two interventions. A Violence Prevention Program (VPP) focused on risk factors for violence, and a Positive Youth Development Program (PYDP) focused on protective factors. Program effects on violence outside of and in school were assessed at 6 and 12 months.

METHODS

Both interventions included an 8-week internet-based program and an in-person youth summit. Participants were prospectively randomized twice, first to the VPP and a no-VPP control group and again to the PYDP and a no-PYDP control group. Participants self-reported violence outside of and in school through self-administered baseline surveys with repeat assessments at 6 and 12 months. Analysis of covariance models examined VPP and PYDP effects on violence.

RESULTS

The analysis sample was 86% Latino, 56% female, 36% aged 10-13 years, 45% aged 14-18, and 19% aged 19-23 years. Analysis of covariance models of violence outside of school demonstrated small program interaction effects at 6 months (partial eta² = .030; p = .007) and small VPP effects at 12 months (partial eta² = .023; p = .025). Models of violence in school demonstrated small PYDP effects at 6 months (partial eta² = .023; p = .018).

CONCLUSIONS

Community-Based Participatory Action Research engaging adolescents, young adults, and parents to address locally relevant health issues can have multiple benefits. In this study, a VPP had positive effects on violence outside of school at 12 months, and a PYDP had positive effects on violence in school at 6 months.

The role of self-efficacy and information processing in weight loss during an mHealth behavioral intervention

Self-efficacy (SE) and information processing (IP) may be important constructs to target when designing mHealth interventions for weight loss. The goal of this study was to examine the relationship between SE and IP with weight loss at six-months as part of the Dietary Interventions Examining Tracking with mobile study, a six-month randomized trial with content delivered remotely via twice-weekly podcasts. Participants were randomized to self-monitor their diet with either a mobile app (n = 42) or wearable Bite Counter device (n = 39). SE was assessed using the Weight Efficacy Life-Style Questionnaire and the IP variables assessed included user control, cognitive load, novelty, elaboration. Regression analysis examined the relationship between weight loss, SE change & IP at six months. Results indicate that elaboration was the strongest predictor of weight loss (ß =−0.423, P = 0.011) among all SE & IP variables and that for every point increase in elaboration, participants lost 0.34 kg body weight.

Differential Programming Needs of College Students Preferring Web-Based Versus In-Person Physical Activity Programs

College students report several barriers to exercise, highlighting a need for university-based programs that address these challenges. In contrast to in-person interventions, several web-based programs have been developed to enhance program engagement by increasing ease of access and lowering the necessary level of commitment to participate. Unfortunately, web-based programs continue to struggle with engagement and less-than-ideal outcomes. One explanation for this discrepancy is that different intervention modalities may attract students with distinctive activity patterns, motivators, barriers, and program needs. However, no studies have formally evaluated intervention modality preference (e.g., web-based or in-person) among college students. The current study sought to examine the relationship between intervention modality preference and physical activity programming needs. Undergraduate students (n = 157) enrolled in psychology courses at an urban university were asked to complete an online survey regarding current activity patterns and physical activity program preferences. Participants preferring web-based physical activity programs exercised less (p = .05), were less confident in their abilities to exercise (p = .01), were less likely to endorse the maintenance stage of change (p < .01) and perceived more barriers to exercising (p < .01) than those who preferred in-person programming. Findings suggest that students preferring web-based programming may require programs that enhance self-efficacy by fostering goal-setting and problem-solving skills. A user-centered design approach may enhance the engagement (and therefore effectiveness) of physical activity promotion programs for college students.

Digital Media-based Health Intervention on the promotion of Women's physical activity: a quasi-experimental study

Background

Technological advances have caused poor mobility and lower physical activity among humankind. This study was conducted to assess the impact of a digital media-based (multi-media, internet, and mobile phone) health intervention on promotion of women’s physical activity.

Methods

In this quasi-experimental study, 360 women were divided into case and control groups. The digital media-based educational intervention was conducted in two months in the case group electronically, using mail and Internet and telephone platforms. Physical activity was measured using International Physical Activity Questionnaire (IPAQ) that estimated women’s physical activity rate in the previous week. Data was analyzed using descriptive and analytical statistics (ANOVA, chi-square, paired and independent t-tests) using SPSS 20.

Results

The mean score of knowledge, attitude and level of physical activity in the control group were not significantly different before and after the intervention. While in the case group, this difference before and after the intervention was significant (p < 0.001), and mean scores of the above-mentioned factors increased after the intervention.

Conclusions

Using innovative and digital media-based health education can be effective in improving health-based behavior such as physical activity. Therefore, it seems necessary to develop user-based strategies and strengthen the behavioral change theories and hypotheses based on digital media for effective influence on behavior.

Trial registration

Iranian Registry of Clinical Trials (IRCT), IRCT20160619028529N5. Registered December 24, 2017 [retrospectively registered].

A Systematic Review on Effect of Electronic Media on Diet, Exercise, and Sexual Activity among Adolescents

Context

Electronic media has become a part of day-to-day life for all, and particularly more so for children and adolescents. Exposure to electronic media may be beneficial as well as harmful.

Aim

The aim of the study is to systematically synthesize existing published and non-published empirical evidence on the effect of exposure to electronic media on diet, exercise, and sexual activity.

Methodology

Two reviewers independently searched online databases such as MEDLINE, CENTRAL, and EMBASE. We applied no language, date, or publication restrictions.

Selection Criteria

We included randomized control trials that assessed the effect of exposure of electronic media on diet, exercise, and sexual activity in participants between 5 and 19 years.

Study Selection Data Extraction

Two reviewers independently screened studies identified in electronic search and independently extracted data and assessed the risk of bias of included studies.

Data Analysis

We had planned to use the risk ratio or odds ratio for dichotomous data, and mean difference (MD) or standardized MD for continuous data. However, as included studied differed in types of intervention and reporting of outcomes, we did not undertake meta-analysis.

Main Results

All included trials were parallel randomized controlled trials except for one that was a crossover trial. Eight studies reported the effect of electronic media on diet and exercise, two on diet, two on exercise, and one on sexual activity. Quality of evidence was rated as "very low" for all outcomes due to too little information or too few data to be able to reach to any conclusions.

Conclusions

There is a little body of evidence that limits conclusions. We need to comprehend as to how to swap undesirable effects of electronic media and make it more desirable.

Registration of Systematic Review

This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86935.

External supports in reward-based crowdfunding campaigns

Purpose

The purpose of this paper is to discuss some drivers which can promote reward-based crowdfunding campaigns and then compare their effects on two categories of cultural and creative projects.

Design/methodology/approach

The authors first distinguished the roles of “intrinsic qualities” and “external supports” in crowdfunding campaigns. Then based on the theories of reward-based crowdfunding, impression management and social capital, a research model was built to discuss the effects of external supports and a comparative study was conducted by using data collected from Kickstarter.com.

Findings

It indicates that the three dimensions of external supports (reward support, impression support, and relationship support) have positive effects on film and video and publishing projects. Besides, the authors also found that “category of a project” can moderate the relationship between impression support and crowdfunding performance. The effect of impression support on visual works is different from that on printed works.

Research limitations/implications

These findings not only prove that external supports actually play an important role in crowdfunding campaigns, but also reveal that for different categories of cultural and creative crowdfunding projects, the effects of external supports are different. Some other theoretical and practical implications are also provided.

Originality/value

This research reveals some details about the important role of external supports in crowdfunding campaigns and compares their effects on different categories of cultural and creative projects. It can provide useful suggestions for improving reward-based crowdfunding performance.

[Electronic media in obesity prevention in childhood and adolescence]

BACKGROUND

The increasing prevalence of childhood obesity is - amongst other factors - due to changed leisure time habits with decreased physical activity and increased media consumption. However, electronic media such as tablets and smartphones might also provide a novel intervention approach to prevent obesity in childhood and adolescence.

OBJECTIVES

A summary of interventions applying electronic media to prevent childhood obesity is provided to investigate short term effects as well as long term results of these interventions.

METHODS

A systematic literature search was performed in PubMed/Web of Science to identify randomized and/or controlled studies that have investigated the efficacy of electronic media for obesity prevention below the age of 18.

RESULTS

A total of 909 studies were identified, and 88 studies were included in the analysis. Active video games did increase physical activity compared to inactive games when applied within a peer group. Interventions via telephone had positive effects on certain lifestyle-relevant behaviours. Interventions via mobile were shown to decrease dropout rates by sending regular SMS messages. To date, interventions via smartphones are scarce for adolescents; however, they might improve cardiorespiratory fitness. The results from internet-based interventions showed a trend towards positive effects on lifestyle-relevant behaviors. The combination of different electronic media did not show superior results compared to interventions with only one medium. Interventions via TV, DVD or video-based interventions may increase physical activity when offered as an incentive, however, effects on weight status were not observed.

DISCUSSION

Children and adolescents currently grow up in a technology- and media-rich society with computers, tablets, smartphones, etc. used daily. Thus, interventions applying electronic media to prevent childhood obesity are contemporary. Available studies applying electronic media are however heterogeneous in terms of applied medium and duration. Positive effects on body composition were not observed, but only on certain lifestyle-relevant behaviours. In addition, these effects could only be seen in the short term. Follow-up data are currently scarce.

Effectiveness of computer-aided learning in oral health among patients and caregivers: a systematic review

Computer-aided learning (CAL) offers enormous potential in disseminating oral health care information to patients and caregivers. The effectiveness of CAL, however, remains unclear.

OBJECTIVES

The purpose of this study was to systematically review published evidence on the effectiveness of CAL in disseminating oral health care information to patients and caregivers.

MATERIALS AND METHODS

A structured comprehensive search was undertaken among 7 electronic databases (PUBMED, CINAHL Plus, EMBASE, SCOPUS, WEB of SCIENCE, the Cochrane Library, and PsycINFO) to identify relevant studies. Randomized controlled trials (RCTs) and observational studies were included in this review. Papers were screened by 2 independent reviewers, and studies that met the inclusion criteria were selected for further assessment.

RESULTS

A total of 2915 papers were screened, and full texts of 53 potentially relevant papers (κ = 0.885) were retrieved. A total of 5 studies that met the inclusion criteria (1 RCT, 1 quasi-experimental study, and 3 post-intervention studies) were identified. Outcome measures included knowledge, attitude, behavior, and oral health. Significant improvements in clinical oral health parameters (P < .05) and knowledge/attitudes (P < .001) were reported in 2 of the studies. The 3 remaining studies reported improved oral health behaviors and confidence.

CONCLUSION

There is a limited number of studies which have examined the effectiveness of CAL interventions for oral health care among patients and caregivers. Synthesis of the data suggests that CAL has positive impacts on knowledge, attitude, behavior, and oral health. Further high- quality studies on the effectiveness of CAL in promoting oral health are warranted.

Interdisciplinary, child-centred collaboration could increase the success of potentially successful Internet-based physical activity interventions

Physical activity promotes health in children and adolescents, but activity levels are low. The Internet offers opportunities for physical activity interventions because children and adolescents are widely exposed to the web and enjoy being online. This review investigated the success of Internet-based interventions designed to increase physical activity in children and adolescents. Of the 13 studies we included, five reported that Internet-based interventions had significant effects on most physical activities.

CONCLUSION

Internet-based physical activity interventions in children and adolescents are potentially successful, but interdisciplinary, child-centred collaboration is needed to design interventions that align with their Internet experiences and preferences.

Evaluation of physical activity interventions in youth via the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: A systematic review of randomised and non-randomised trials

CONTEXT

An identified limitation of existing reviews of physical activity interventions in school-aged youth is the lack of reporting on issues related to the translatability of the research into health promotion practice.

OBJECTIVE

This review used the Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance framework to determine the extent to which intervention studies promoting physical activity in youth report on factors that inform generalizability across settings and populations.

METHODS AND RESULTS

A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting.

CONCLUSIONS

Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues.

Evaluation of a Resource for Adolescents and Young Adults Diagnosed With Cancer

Purpose: Adolescents and young adults (AYAs) have a need for information about their cancer diagnosis. The purpose of this study was to evaluate a book for AYAs diagnosed with cancer, in particular to assess satisfaction, changes in perceived knowledge and coping, the impact of health literacy (HL) on perceived knowledge, and the impact of the book on distress levels. Methods: Forty-six AYAs (12-24 years of age) completed questionnaires before and after receiving the Now What . . . ? book designed to provide broad and comprehensive information to AYAs with cancer. Results: Overall satisfaction with the book was excellent. Levels of perceived knowledge increased in several domains; however, levels of distress, which were elevated, did not improve after participants received the book. Levels of HL related to prebook perceived knowledge, but not to postbook perceived knowledge, suggested that the book is useful for people with all levels of HL. Conclusions: The usefulness and high levels of satisfaction with the book, including the qualitative feedback, demonstrate the potential benefit of the Now What . . . ? books for AYA patients diagnosed with cancer.

The differentiated effectiveness of a printed versus a Web-based tailored physical activity intervention among adults aged over 50

This study provides insight in the effectiveness of a print-delivered and a Web-based physical activity (PA) intervention (with or without additional environmental information on local PA possibilities) among people aged over 50. Intervention groups (print-delivered basic [PB; n = 439], print-delivered environmental [PE; n = 435], Web-based basic [WB; n = 423], Web-based environmental [WE; n = 432]) and a control group (n = 411) were studied in a clustered randomized controlled trial. Participants received three times tailored advice within four months, targeting the psychosocial determinants of PA, and additional environmental information (in two conditions). Outcome measures include weekly minutes and days of sufficient PA 6 months after the start, considering age, gender, educational level, body mass index, the presence of a chronic physical limitation and PA intentions as possible effect moderators. The results showed that the PB (B = 192.47; 95% CI = 75.24-309.71; P = 0.003), the PE (B = 229.31; 95% CI = 108.73-349.89; P = 0.001) and the WB-intervention condition (B = 214.25; 95% CI 88.65-339.85; P = 0.002) resulted in significantly increased weekly minutes of PA. Only the printed conditions resulted in increased days of sufficient PA (PB: B = 0.63; 95% CI = 0.35-0.92; P < 0.001; PE: B = 0.55; 95% CI = 0.26-0.85; P = 0.001). Additional environmental information did not increase intervention effects. Differences in effect were found between age and gender subgroups. In conclusion, both printed and Web-based interventions can be effective in increasing PA in adults aged over 50.

Information processing versus social cognitive mediators of weight loss in a podcast-delivered health intervention

Podcasting is an emerging technology, and previous interventions have shown promising results using theory-based podcast for weight loss among overweight and obese individuals. This study investigated whether constructs of social cognitive theory and information processing theories (IPTs) mediate the effect of a podcast intervention on weight loss among overweight individuals. Data are from Pounds off Digitally, a study testing the efficacy of two weight loss podcast interventions (control podcast and theory-based podcast). Path models were constructed (n = 66). The IPTs, elaboration likelihood model, information control theory, and cognitive load theory mediated the effect of a theory-based podcast on weight loss. The intervention was significantly associated with all IPTs. Information control theory and cognitive load theory were related to elaboration, and elaboration was associated with weight loss. Social cognitive theory constructs did not mediate weight loss. Future podcast interventions grounded in theory may be effective in promoting weight loss.

iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention

BACKGROUND

Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps.

METHOD

Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity.

RESULTS

App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed.

CONCLUSIONS

Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To conduct a systematic review of randomised controlled trials (RCTs) examining the use of social media to promote healthy diet and exercise in the general population.

DATA SOURCES

MEDLINE, CENTRAL, ERIC, PubMed, CINAHL, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest Dissertation and Thesis (2000-2013).

STUDY ELIGIBILITY CRITERIA

RCTs of social media interventions promoting healthy diet and exercise behaviours in the general population were eligible. Interventions using social media, alone or as part of a complex intervention, were included.

STUDY APPRAISAL AND SYNTHESIS

Study quality was assessed using the Cochrane Risk of Bias Tool. We describe the studies according to the target populations, objectives and nature of interventions, outcomes examined, and results and conclusions. We extracted data on the primary and secondary outcomes examined in each study. Where the same outcome was assessed in at least three studies, we combined data in a meta-analysis.

RESULTS

22 studies were included. Participants were typically middle-aged Caucasian women of mid-to-high socioeconomic status. There were a variety of interventions, comparison groups and outcomes. All studies showed a decrease in programme usage throughout the intervention period. Overall, no significant differences were found for primary outcomes which varied across studies. Meta-analysis showed no significant differences in changes in physical activity (standardised mean difference (SMD) 0.13 (95% CI -0.04 to 0.30), 12 studies) and weight (SMD -0.00 (95% CI -0.19 to 0.19), 10 studies); however, pooled results from five studies showed a significant decrease in dietary fat consumption with social media (SMD -0.35 (95% CI -0.68 to -0.02)).

CONCLUSIONS

Social media may provide certain advantages for public health interventions; however, studies of social media interventions to date relating to healthy lifestyles tend to show low levels of participation and do not show significant differences between groups in key outcomes.

Differences in the use and appreciation of a web-based or printed computer-tailored physical activity intervention for people aged over 50 years

This study provides insight into the use and appreciation of a tailored physical activity intervention for people aged over 50 years in different intervention conditions (i.e. printed versus web-based and basic versus environmental). Participants (within a clustered randomized controlled trial) received printed or web-based-tailored advice three times within 4 months. Half of the participants also received environmental information. Differences in use and appreciation between both delivery modes and between the basic and environmental condition (similar delivery mode) were assessed at 3 (N = 935) and 6 (N = 649) months after baseline using analyses of variance and chi-square test. The use of the printed intervention (i.e. 92.7-98.2% read, 70.1-76.5% kept and 39.9-56.8% discussed) was significantly higher and printed intervention components were better appreciated than web-based intervention (scores, respectively, 6.06-6.91 versus 5.05-6.11 on a scale of 1-10). In-depth appreciation (e.g. reliability, perceived individualization) was average to high, without differences between intervention conditions. Additional environmental information did not increase appreciation; however, environmental intervention components were more used compared with basic intervention components. Integration of environmental components can stimulate active use of the intervention. To increase the public impact and prevent dropout by participants of web-based physical activity interventions, design modifications are needed for ease of use and improved appreciation.

Development and functionality of a handheld computer program to improve fruit and vegetable intake among low-income youth

Mobile technologies hold promise for improving diet and physical activity, but little attention is given to creating programs that adolescents like and will use. This study developed a personal digital assistant (PDA) program to promote increased intake of fruits and vegetables (FV) in predominately low-income, ethnic minority girls. This study used a three-phase community-engaged process, including (i) engagement of a Student Advisory Board (SAB) to determine comfort with PDAs; (ii) early testing of Prototype I and rapid re-design by the SAB and (iii) feasibility testing of Prototype II in a new sample of girls. Phase 1 results showed that girls were comfortable with the PDA. Testing of Prototype I in Phase 2 showed that acceptability was mixed, with girls responding to 47.3% of the prompts. Girls wanted more reminders, accountability in monitoring FV, help in meeting daily goals and free music downloads based on program use. The PDA was reprogrammed and testing of Prototype II in Phase 3 demonstrated marked improvement in use (78.3%), increases in FV intake (1.8 ± 2.6 daily servings) and good overall satisfaction. Findings suggest that mobile technology designed with the early input of youth is a promising way to improve adolescent health behaviors.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades.

OBJECTIVES

The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH METHODS

The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured.

MAIN RESULTS

In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review.

AUTHORS' CONCLUSIONS

The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.

Differences in reach and attrition between Web-based and print-delivered tailored interventions among adults over 50 years of age: clustered randomized trial

Background

The Internet has the potential to provide large populations with individual health promotion advice at a relatively low cost. Despite the high rates of Internet access, actual reach by Web-based interventions is often disappointingly low, and differences in use between demographic subgroups are present. Furthermore, Web-based interventions often have to deal with high rates of attrition.

Objective

This study aims to assess user characteristics related to participation and attrition when comparing Web-based and print-delivered tailored interventions containing similar content and thereby to provide recommendations in choosing the appropriate delivery mode for a particular target audience.

Methods

We studied the distribution of a Web-based and a print-delivered version of the Active Plus intervention in a clustered randomized controlled trial (RCT). Participants were recruited via direct mailing within the participating Municipal Health Council regions and randomized to the printed or Web-based intervention by their region. Based on the answers given in a prior assessment, participants received tailored advice on 3 occasions: (1) within 2 weeks after the baseline, (2) 2 months after the baseline, and (3) within 4 months after the baseline (based on a second assessment at 3 months). The baseline (printed or Web-based) results were analyzed using ANOVA and chi-square tests to establish the differences in user characteristics between both intervention groups. We used logistic regression analyses to study the interaction between the user characteristics and the delivery mode in the prediction of dropout rate within the intervention period.

Results

The printed intervention resulted in a higher participation rate (19%) than the Web-based intervention (12%). Participants of the Web-based intervention were significantly younger (P<.001), more often men (P=.01), had a higher body mass index (BMI) (P=.001) and a lower intention to be physically active (P=.03) than participants of the printed intervention. The dropout rate was significantly higher in the Web-based intervention group (53%) compared to the print-delivered intervention (39%, P<.001). A low intention to be physically active was a strong predictor for dropout within both delivery modes (P<.001). The difference in dropout rate between the Web-based and the printed intervention was not explained by user characteristics.

Conclusions

The reach of the same tailored physical activity (PA) intervention in a printed or Web-based delivery mode differed between sociodemographic subgroups of participants over 50 years of age. Although the reach of the Web-based intervention is lower, Web-based interventions can be a good channel to reach high-risk populations (lower PA intention and higher BMI). While the dropout rate was significantly higher in the Web-based intervention group, no specific user characteristics explained the difference in dropout rates between the delivery modes. More research is needed to determine what caused the high rate of dropout in the Web-based intervention.

Trial Registration

Dutch Trial Register (NTR): 2297: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp).

What design features are used in effective e-health interventions? A review using techniques from Critical Interpretive Synthesis

The effectiveness of e-health interventions varies greatly. Despite this, there has been relatively little formal consideration of how differences in the design of an intervention (i.e., how the content is delivered) may explain why some interventions are more effective than others. This review primarily examines the use of the Internet to provide educational and self-management interventions to promote health. The article develops hypotheses about how the design of these interventions may be associated with outcomes. In total, 52 published reports from both a diversity sample and a representative sample were reviewed using techniques from Critical Interpretive Synthesis. Four core interactive design features were identified that may mediate the effects of intervention design on outcomes: Social context and support, contacts with intervention, tailoring, and self-management. A conceptual framework to summarize the design of e-health interventions delivered using the Internet is proposed. The framework provides a guide for systematic research to identify the effects of specific design features on intervention outcomes and to identify the mechanisms underlying any effects. To optimize the design of e-health interventions more work is needed to understand how and why these design features may affect intervention outcomes and to investigate the optimal implementation and dosage of each design feature.

The use of web-based interventions to prevent excessive weight gain

We reviewed web-based interventions for overweight and obesity prevention. A literature search was conducted using seven electronic databases. Manually searched articles were also included. Thirty studies fulfilled the inclusion criteria. Of these, 13 studied physical activity, eight studied dietary practices and nine studied a combination of physical activity and dietary practice. Twenty-eight of the studies (93%) reported positive changes in moderate to vigorous physical activity level, fruit and vegetable intake and psychological factors. A meta-analysis showed there were improvements, though not significant, in fruit and vegetable consumption (standardised mean difference, SMD = 0.61; 95% CI =-0.13 to 1.35) and physical activity (SMD = 0.15; 95% CI =-0.06 to 0.35). The review suggests that web-based interventions are a useful educational tool for increasing awareness and making healthy behaviour changes in relation to an excessive weight gain problem.

An investigation of the theoretical content of physical activity brochures

New evidence-based physical activity guidelines and recommendations for constructing messages supplementing the guidelines have been put forth. As well, recent reviewshave identified theoretical constructs that hold promise as targets for intervention: self-regulation, outcome expectancies and self-efficacy. The purpose of this study was to examine the integration of messages targeting self-regulation, self-efficacy and outcome expectancies in existing physical activity brochures. Twenty-two PA brochures from Canadian and American National Health Organizations were assessed for their use self-efficacy, self-regulatory processes and outcome expectancies. Brochures were analyzed line-by-line using a modified version of the validated Content Analysis Approach to Theory-Specified Persuasive Educational Communication (CAATSPEC; Abraham et al., 2007). One third of the brochures were coded by two independent raters coded a third of the brochures (n = 7). Inter-rater reliability was acceptable for 17 of the 20 categories (rs> .79). Discrepancies in all categories were discussed and agreement was reached. The remaining brochures were coded by one of the two raters. Usage of thethree key theoretical constructs accounted for only 36.43% of brochure content (20.23% self-efficacy, 10.40% outcome expectancies, 5.80% self-regulation). Brochures lacked the use of a variety of theoretical strategies, specifically goal-setting, planning and verbal persuasion and rarely highlighted the affective benefits of physical activity. In the future brochures should aim to place increased emphasis on self-regulation, self-efficacy, and affective outcome expectancies.

A systematic review of information and communication technology-based interventions for promoting physical activity behavior change in children and adolescents

Background

A growing body of research has employed information and communication technologies (ICTs) such as the Internet and mobile phones for disseminating physical activity (PA) interventions with young populations. Although several systematic reviews have documented the effects of ICT-based interventions on PA behavior, very few have focused on children and adolescents specifically.

Objectives

The present review aimed to systematically evaluate the efficacy and methodological quality of ICT-based PA interventions for children and adolescents based on evidence from randomized controlled trials.

Methods

Electronic databases Medline, PsycInfo, CINAHL, and Web of Science were searched to retrieve English language articles published in international academic peer-reviewed journals from January 1, 1997, through December 31, 2009. Included were articles that provided descriptions of interventions designed to improve PA-related cognitive, psychosocial, and behavioral outcomes and that used randomized controlled trial design, included only children (6-12 years old) and adolescents (13-18 years old) in both intervention and control groups, and employed Internet, email, and/or short message services (SMS, also known as text messaging) as one or more major or assistive modes to deliver the intervention.

Results

In total, 9 studies were analyzed in the present review. All studies were published after 2000 and conducted in Western countries. Of the 9 studies, 7 demonstrated positive and significant within-group differences in at least one psychosocial or behavioral PA outcome. In all, 3 studies reported positive and significant between-group differences favoring the ICT group. When between-group differences were compared across studies, effect sizes were small in 6 studies and large in 3 studies. With respect to methodological quality, 7 of the 9 studies had good methodological quality. Failure to report allocation concealment, blinding to outcome assessment, and lack of long-term follow-up were the criteria met by the fewest studies. In addition, 5 studies measured the intervention exposure rate and only 1 study employed objective measures to record data.

Conclusion

The present review provides evidence supporting the positive effects of ICTs in PA interventions for children and adolescents, especially when used with other delivery approaches (ie, face-to-face). Because ICT delivery approaches are often mixed with other approaches and these studies sometimes lack a comparable control group, additional research is needed to establish the true independent effects of ICT as an intervention delivery mode. Although two-thirds of the studies demonstrated satisfactory methodological quality, several quality criteria should be considered in future studies: clear descriptions of allocation concealment and blinding of outcome assessment, extension of intervention duration, and employment of objective measures in intervention exposure rate. Due to the small number of studies that met inclusion criteria and the lack of consistent evidence, researchers should be cautious when interpreting the findings of the present review.

A review of electronic interventions for prevention and treatment of overweight and obesity in young people

The objective of this systematic review is to provide a qualitative comparison of interactive electronic media interventions for the prevention or treatment of obesity and/or obesity-related behaviours in children and adolescents. Literature searches of 12 databases from the earliest publication date until March 2010 were conducted. Twenty-four studies in which children and/or adolescents interacted with electronic interventions delivered as adjunct or sole interventions for the prevention or treatment of obesity and/or obesity-related behaviours met the inclusion criteria. Fifteen focussed on obesity prevention and nine on treatment interventions. The average study quality design score was 45%. Most studies demonstrated some form of significant outcome (e.g. reported changes in dietary and/or physical activity behaviours) in participants receiving interactive electronic interventions, with 11 out of 15 studies leading to positive changes in measured or reported adiposity outcomes. In 87% of studies, the effects of interactive electronic interventions were not separately evaluated from other intervention components. These results should be viewed with caution because of the overall poor quality of the studies. Studies were mostly conducted in the USA, largely in minority populations, and the direct transferability of interventions to other populations is unclear. Further high quality research is needed in this area to accurately inform the evidence base.

Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: a systematic review

The Internet is considered to be a promising delivery channel of interventions aimed at promoting healthful behaviors, especially for adolescents and young adults. Exposure to these interventions, however, is generally low. A more extensive exploration of methods, strategies, and their effectiveness with regard to facilitating exposure is therefore timely, because this knowledge is crucial to improve the use of such interventions and, subsequently, to increase behavioral change. Therefore, a systematic review of the literature was conducted, resulting in 838 studies based on title selection, of which 26 studies met the eligibility criteria. The systematic review resulted in an overview of methods and strategies that have been used to facilitate exposure. Patterns of effective strategies could be observed, such as the combination of tailored communication and the use of reminders and incentives. Nevertheless, exposure-specific theories need to be developed and objective exposure measures should be tracked and reported in future studies.

Computer- and web-based interventions to increase preadolescent and adolescent physical activity: a systematic review

AIM

This review examined evidence regarding computer- or web-based interventions to increase preadolescent and adolescent physical activity.

BACKGROUND

Today's youth are less active and more overweight than their counterparts from 25 years ago. Overweight youth tend to become overweight adults with weight-related maladies, including type 2 diabetes and cardiovascular problems. Interventions to increase physical activity that reach a large audience are needed. Computer- and web-based physical activity interventions are an appealing means to influence physical activity in preadolescents and adolescents. However, their effectiveness must be determined.

DATA SOURCES

The following electronic databases were searched for studies published from 1998 through 2010: CINAHL, PubMed, PsycINFO, Sociological Abstracts, SportDISCUS and Proquest.

REVIEW METHODS

A systemic review was conducted. Fourteen randomized control trials or quasi-experimental studies were reviewed to: (1) determine the effect of computer- or web-based interventions on increasing physical activity and/or improving body mass index, weight, percent body fat or waist circumference as a result of increasing physical activity; and (2) examine if additional components associated with these interventions increased success.

RESULTS

  Although most interventions demonstrated statistically significant increases in physical activity or positive health changes related to physical activity, findings were small or short-lived. The value of conducting the interventions at school, using a theory or model as a framework, and supplementing with individual tailoring and parental involvement, is discussed.

CONCLUSION

Computer- and web-based interventions can promote physical activity among preadolescents and adolescents, particularly in schools. However, further efforts are needed to sustain positive changes.

Surfing depth on a behaviour change website: predictors and effects on behaviour

The primary objectives of the present study were to gain insight into website use and to predict the surfing depth on a behaviour change website and its effect on behaviour. Two hundred eight highly educated adults from the intervention condition of a randomised trial received access to a medical intervention, individual coaching (by e-mail, post, telephone or face-to-face) and a behaviour change website. Website use (e.g. surfing depth, page view duration) was registered. Online questionnaires for physical activity and fat intake were filled out at baseline and after 6 months. Hierarchical linear regression was used to predict surfing depth and its effect on behaviour. Seventy-five per cent of the participants visited the website. Fifty-one and fifty-six per cent consulted the physical activity and fat intake feedback, respectively. The median surfing depth was 2. The total duration of interventions by e-mail predicted deeper surfing (beta=0.36; p<0.001). Surfing depth did not predict changes in fat intake (beta=-0.07; p=0.45) or physical activity (beta=-0.03; p=0.72). Consulting the physical activity feedback led to more physical activity (beta=0.23; p=0.01). The findings from the present study can be used to guide future website development and improve the information architecture of behaviour change websites.

A meta-analytic review of eHealth interventions for pediatric health promoting and maintaining behaviors

OBJECTIVE

The current study quantitatively evaluated the impact of eHealth interventions on pediatric health promoting and maintaining behaviors believed to impact the development or worsening of a physical disease and their associated outcomes.

METHOD

PsycINFO, PUBMED/MEDLINE, Educational Resources Information Center (ERIC), and reference sections of identified articles were searched.

RESULTS

An omnibus weighted mean effect size for all identified eHealth interventions revealed a small, but significant, effect (mean d = .118, 95% confidence interval [CI] = .066-.171). However, when considered independently, educational interventions demonstrated no significant effect on pediatric health behavior or health outcomes. Behavioral eHealth interventions produced relatively homogeneous effects that were small but significantly different from zero (mean d = .354, 95% CI = .232-.475).

CONCLUSION

eHealth interventions that incorporate behavioral methods (e.g., self-monitoring, goal setting, immediate feedback, contingency management) produce larger effect sizes for health behaviors and their associated outcomes than interventions that rely solely on education.

Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy

BACKGROUND

The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness.

OBJECTIVES

The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes.

METHODS

We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention.

RESULTS

We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d(+) = 0.16, 95% CI 0.09 to 0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d(+) = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages.

CONCLUSIONS

The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery.

Pounds Off Digitally study: a randomized podcasting weight-loss intervention

BACKGROUND

As obesity rates rise, new weight-loss methods are needed. Little is known about the use of podcasting (audio files for a portable music player or computer) to promote weight loss, despite its growing popularity.

DESIGN

A 12-week RCT was conducted.

SETTING/PARTICIPANTS

The study sample comprised overweight men and women (BMI=25-40 kg/m(2); n=78) in the Raleigh-Durham NC area.

INTERVENTION

In 2008, participants were randomly assigned to receive 24 episodes of a currently available weight-loss podcast (control podcast) or a weight-loss podcast based on social cognitive theory (SCT) designed by the researchers (enhanced podcast) for 12 weeks.

MAIN OUTCOME MEASURES

Weight was measured on a digital scale at baseline and follow-up. Both groups also completed questionnaires assessing demographic information, food intake, physical activity, and SCT constructs at the introductory and 12-week meetings. Additional questionnaires at the 12-week meeting assessed perceptions of the intervention.

RESULTS

Data collection and analysis occurred in 2008 and intention-to-treat was used. Enhanced group participants (n=41) had a greater decrease in weight (-2.9+/-3.5 kg enhanced group vs -0.3+/-2.1 control group; p<0.001 between groups) and BMI (-1.0+/-1.2 kg/m(2) enhanced group vs -0.1+/-0.7 kg/m(2) control group; p<0.001 between groups) than the control group (n=37) and had greater weight-loss-related knowledge (p<0.05), elaboration (p<0.001), and user control (p<0.001) and less cognitive load (p<0.001).

CONCLUSIONS

The results of this study suggest that the use of behavioral, theory-based podcasting may be an effective way to promote weight loss.

TRIAL REGISTRATION

NCT00771095.

Web-based weight management programs for children and adolescents: a systematic review of randomized controlled trial studies

More than 17% of children aged 6 to 19 years living in the United States are classified as overweight. Medical costs related to overweight and obesity were recently estimated to approximate $100 billion annually. The purpose of this systematic review was to provide the scientific evidence regarding Web-based weight management programs for overweight children and adolescents. Results suggest the potential for Web-based behavioral change programs for weight management in overweight children and adolescents. Future research should emphasize rigorous methodological adequacies, develop theory-based standardized frameworks, investigate types of interventions appropriate for boys and girls in this age group, evaluate long-term effect of interventions, and examine cost as well as clinical effectiveness.

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.

Association of multiple behavioral risk factors with adolescents' willingness to engage in eHealth promotion

OBJECTIVE

This study examines adolescents' willingness to use the internet and other forms of technology for health promotion purposes (i.e., "eHealth promotion" willingness) and determines if a relationship exists between adolescents' behavioral risks and their eHealth promotion willingness.

METHODS

A total of 332 adolescents provided data at a routine medical check-up, including assessments of technology access, eHealth promotion willingness, and multiple behavioral risk factors for child- and adult-onset disease (body mass index, physical activity, smoking, sun protection, depression).

RESULTS

The level of access to technology among the sample was high, with moderate willingness to engage in eHealth promotion. After adjusting for adolescents' access to technology, the presence of multiple behavioral risk factors was positively associated with willingness to use technology for health promotion purposes (beta =.12, p =.03).

CONCLUSIONS

Adolescents with both single and multiple behavioral risk factors are in need of health promotion to prevent the onset of disease later in life. eHealth appears to be an acceptable and promising intervention approach with this population.

The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial

OBJECTIVE

To test and compare the efficacy of interactive- and print-delivered computer-tailored nutrition education targeting saturated fat intake reduction.

DESIGN

A 3-group randomized, controlled trial (2003-2005) with posttests at 1 and 6 months post-intervention.

SETTING

Worksites and 2 neighborhoods in the urban area of Rotterdam.

PARTICIPANTS

A convenience sample of healthy Dutch adults (n = 442).

INTERVENTIONS

An interactive, computer-tailored intervention delivered on a CD-ROM (interactive-tailored condition); a print-delivered, computer-tailored intervention (print-tailored condition); and print-delivered, generic information.

MAIN OUTCOME MEASURES

Total and saturated fat intake (grams/day and percentage-energy) and energy intake per day assessed with validated food frequency questionnaires at 1 and 6 months post-intervention.

ANALYSIS

Multilevel linear regression analyses.

RESULTS

Mean total fat, saturated fat, and energy intakes were significantly lower in both tailored conditions compared to the generic condition at 1-month follow-up. These differences were still significant for the print-tailored condition at 6-months follow-up. Effects were most pronounced among participants with unfavorable fat intakes at baseline. There were no significant differences between the 2 tailoring conditions.

CONCLUSIONS AND IMPLICATIONS

The results indicate that interactive and print-delivered computer-tailored interventions can have similar short-term effects on fat intake and that the effects of the print-delivered tailored feedback are maintained in the longer term.

Real world use of an Internet intervention for pediatric encopresis

Background

The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions.

Objective

This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a “real world” setting.

Methods

Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time.

Results

Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis.

Conclusions

To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a “real world” setting. This is an important step toward establishing Internet interventions as an adjunctive component to treatment of pediatric patients in a clinical setting, particularly given the positive user feedback, possible cost savings, and significant potential for large-scale dissemination.

Comparison of use and appreciation of a print-delivered versus CD-ROM-delivered, computer-tailored intervention targeting saturated fat intake: randomized controlled trial

Background

Computer-tailored health education, a promising health education technique, is increasingly being delivered interactively, for example, over the Internet. It has been suggested that there may be differences in use and appreciation between print and interactive delivery of computer-tailored interventions, which may influence information processing. This may especially be the case for women, older people, and people of lower socioeconomic status. Knowledge about differences in use and appreciation could help in choosing the appropriate delivery mode for a particular target audience.

Objective

The study investigates a content-identical, computer-tailored intervention addressing saturated fat intake delivered via print or CD-ROM. We analyzed consumer use and appreciation of the feedback information and explored whether possible differences exist among gender, age, and education subgroups.

Methods

Healthy Dutch adults (18-65 years), none of whom were under treatment for hypercholesterolemia, were randomly allocated to receive a computer-tailored program on CD-ROM (n = 151) or in print (n = 141). At baseline, data were collected on gender, age, and education level. One month post-intervention, data were collected on the use (feedback information read, saved, discussed) and appreciation (trustworthiness, perceived individualization, perceived personal relevance, and user-friendliness) of the feedback. Statistical analyses on the use and appreciation items were performed using chi-square tests and independent-samples t tests.

Results

After exclusion of individuals with missing values, a total of 257 and 240 respondents were included in the analyses of the use outcomes of feedback read and saved, respectively. The results indicate that among the total population, the print feedback was read more often than the CD-ROM feedback (95% vs 81%; P = .001) and saved more often than the CD-ROM feedback (97% vs 77%; P < .001). Similar results were found among the gender, age, and education subgroups. After exclusion of individuals who did not read the information and those with missing values, a total of 208-223 respondents were included in the analyses of the use outcome of feedback discussed and the appreciation items. The personal relevance of the print feedback was rated higher than for the CD-ROM-delivered feedback (0.97 vs 0.68; P = .04), but the effect size was small (0.28). These differences in personal relevance were also seen among women (1.06 vs 0.67; P = .04) and respondents aged 35-49 years (1.00 vs 0.58; P = .03), with moderate effect sizes (0.38 and 0.44, respectively).

Conclusions

Despite the possible advantages of interactive feedback, the present study indicates that interactive-delivered feedback was used less and perceived as less personally relevant compared to the print-delivered feedback. These differences in use and appreciation of delivery modes should be taken into consideration when selecting a delivery mode for a specific subgroup in order to optimize exposure.

Trial Registration

ISRCTN 01557410; http://www.webcitation.org/5XMylWleH

Increasing nutrition literacy: testing the effectiveness of print, web site, and game modalities

OBJECTIVE

To examine the effectiveness of three modalities for delivery of nutrition education.

DESIGN

Between-subjects, repeated-measures design.

SETTING

Data were collected at community agencies or during home visits.

PARTICIPANTS

Low-income, European American and African American mothers (N = 155).

INTERVENTION

Participants were exposed to nutrition education material in 1 of 3 modalities (a computer game, The Fantastic Food Challenge; Web site; or pamphlet). Likeability, nutrition knowledge, intention to use, and demographic measures followed the intervention at T1 and T2.

MAIN OUTCOME MEASURES

5-point Likert-type scales measured likeability (5 items), and 33 multiple-choice questions measured knowledge.

ANALYSIS

Data were analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) procedures using SPSS version 15.0 (SPSS Inc., Chicago, IL) software, P < .05.

RESULTS

Overall, the Web site was liked more than the other conditions with this audience of women. Significant differences in attention, understanding, and intent to use the information existed across modalities. The Web site performed better than other modalities on knowledge outcomes, with no differences in knowledge retention from T1 to T2.

CONCLUSIONS AND IMPLICATIONS

The Web site modality performed best with this audience of women, indicating that interactive computer games may not confer greater benefits than traditional modes of information delivery for all audiences, particularly those with low computer skills.