Qualitative evaluation of a social media campaign to improve healthy food habits among urban adolescent females in Indonesia

Community-based interventions addressing multiple forms of malnutrition among adolescents in low- and middle-income countries: a scoping review

BACKGROUND

Community-based interventions hold promise for addressing adolescent malnutrition, but there is limited knowledge of their nature and impact on adolescent nutrition outcomes in low- and middle-income countries (LMICs). This scoping review aimed to characterize community-based adolescent nutrition interventions in LMICs and summarize their effects on adolescent nutrition outcomes.

METHODS

We systematically searched MEDLINE via PubMed, Embase, and CENTRAL through the Cochrane Library for studies published between 2000 and 2023. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Eligible studies included randomized controlled trials and quasi-experimental studies addressing adolescent malnutrition in LMIC community settings, involving adolescents aged 10-19 years. A narrative synthesis was employed to analyze and describe the evidence.

RESULTS

Our review included 37 records from 36 studies conducted in 27 countries. Interventions included micronutrient supplementation, nutrition education, food supplementation and fortification, physical activity education, and multicomponent approaches. The intervention duration ranged from 3 weeks to 2 years, with limited studies grounded in theoretical frameworks. Fifty-seven percent of interventions (n = 21) targeted adolescent girls, indicating a gap in programs for boys and other vulnerable groups, such as out-of-school adolescents and migrants. The intervention delivery agents included research staff and healthcare professionals. The majority of interventions were delivered in person; few utilized social media strategies. Among the studies reviewed, nine out of ten evaluating micronutrient supplementation, six out of seven assessing nutrition education, and seven out of eight examining multicomponent interventions reported improvement in at least one nutrition or diet-related outcome.

CONCLUSIONS

Community-based interventions hold promise for improving adolescent nutritional status in LMICs. However, our review highlights gaps in the evidence base, marked by significant variability in intervention design, delivery, and implementation platforms. This underscores the need for integrated approaches and rigorous evaluations of their implementation outcomes, including acceptability, relevance, feasibility, effectiveness, and sustainability, in addressing adolescent nutrition challenges.

REGISTRATION

The review protocol was registered prospectively with the Open Science Framework on 19 July 2023 ( https://osf.io/t2d78 ).

Validity and reliability of the Persian version of food preferences questionnaire (Persian-FPQ) in Iranian adolescents

The assessment of dietary intakes and habits using reliable and youth-specific measurement tools during adolescence is essential. The aim of the present study was to culturally adapt and investigate the psychometric properties of the Persian version of the food preferences questionnaire (Persian-FPQ) among Iranian adolescents. This methodological cross-sectional study was conducted among 452 Persian-speaking adolescents, living in Isfahan, Iran. Translation of the FPQ was performed using forward-backward method. Intra Class Correlation (ICC) and Cronbach's α were used to assess test-retest reliability and internal consistency, respectively. Construct validity was investigated by using exploratory factor analysis (EFA). Divergent validity was determined using correlation analysis with Kessler Psychological Distress Scale (K-10). Known-group validity was assessed based on differences in mean food preference score between boys and girls and different categories of body mass index (BMI). The internal and external reliabilities for the Persian-FPQ were in the range of good to excellent in all domains (Cronbach's α: 0.76-0.96 and ICCs: 0.982-0.998). Boys had higher scores of food preferences than girls, indicating good known-group validity. Construct validity evaluated by EFA led to extraction of seven factors ("Vegetables", "Fruit", "Dairy", "Snacks", "Meat/Fish", "Starches" and "Miscellaneous foods"), explaining 37.8% of the variance. Divergent validity revealed significant negative correlations between five sub-scales of the Persian-FPQ and psychological distress. The Persian version of the FPQ is a reliable and valid instrument with applicability in a broad range of the population of Persian-speaking adolescents for assessing food preferences in community-based research projects.

The individual-level effects of social media campaigns related to healthy eating, physical activity, and healthy weight: A narrative review

Objective

Social media are promising channels for health communication promoting positive weight-related behaviors, but no prior studies have synthesized evidence on the independent effects of social media campaigns focused on promoting healthy eating, physical activity (PA), and healthy weight. This study aimed to fill that gap and inform future social media-based obesity-prevention research and practice by reviewing findings from studies testing the effects of such campaigns on individual-level cognitive, behavioral, and anthropometric outcomes.

Method

The Web of Science and PubMed databases were searched for peer-reviewed articles published between 2012 and 2023 that explored the independent effects of social media campaigns related to healthy eating, PA, or weight management. Study characteristics and outcomes were extracted and summarized.

Results

Eleven studies were included in this review describing campaigns targeting healthy eating-related outcomes (e.g., fruit and vegetable consumption, meal preparation, nutrition label reading), PA, or weight management. Most campaigns (n = 7) were developed by universities or research centers. Priority audiences included parents, adult females, adolescents, college students, and adult government employees. The majority (n = 8) of the campaigns used single platforms, with the most common being Facebook, Instagram, blogs, and YouTube. Campaigns had mixed effects on cognitive outcomes (e.g., intention, attitude, knowledge), behavioral outcomes (e.g., food choices, PA), and anthropometric outcomes (e.g., weight, waist circumference).

Conclusion

Social media campaigns focused on promoting healthy eating, PA, and healthy weight had mixed effects on individual-level cognitive, behavioral, and anthropometric outcomes. Various limitations of the included studies make it difficult to ascertain which factors influence campaign effectiveness. Advancing knowledge in this area is important, particularly given social media's widespread use and potential for broad reach. New research with features such as rigorous study designs, larger and more diverse samples, and strong theoretical foundations may provide important insights into what types of interventions are effective or not and under what conditions.

Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review

BACKGROUND

Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media-based nutrition education interventions to inform the implementation of future social media-based nutrition education interventions.

OBJECTIVE

A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media-based nutrition education interventions for adolescents was conducted.

METHODS

We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media-based nutrition education interventions was extracted.

RESULTS

A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied.

CONCLUSIONS

Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media-based nutrition interventions and the need for user-centered design of the interventions.

A Model of Social Media Effects in Public Health Communication Campaigns: Systematic Review

BACKGROUND

Social media platforms are frequently used in health communication campaigns. Common understandings of campaign effects posit a sequential and linear series of steps from exposure to behavior change, commonly known as the hierarchy of effects model (HOE). These concepts need to be reevaluated in the age of social media, which are interactional and communal.

OBJECTIVE

This review aims to update the traditional HOE for health communication campaigns in the context of social media, including identifying indicators of effectiveness and how these are conceptualized to lead to health-related outcomes.

METHODS

We conducted a systematic review of studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines reporting on the use of social media as part of health communication campaigns, extracting campaign information such as objectives, platforms used, and measures of campaign performance. We used these data, combined with our understanding of the HOE, to develop an updated conceptual model of social media campaign effects.

RESULTS

We identified 99 eligible studies reporting on 93 campaigns, published between 2012 and 2022. The campaigns were conducted in over 20 countries, but nearly half (n=42) were conducted in the United States. Campaigns targeted a variety of health issues and predominantly used Facebook, Twitter, Instagram, and YouTube. Most campaigns (n=81) set objectives targeting awareness or individual behavior change. Process measures (n=68; eg, reach and impressions) and engagement measures (n=73; eg, likes and retweets) were reported most frequently, while two-fifths (n=42) did not report any outcomes beyond engagement, such as changes in knowledge, behavior, or social norms. Most campaigns (n=55) collected measures that did not allow them to determine if the campaign objective had been met; that is, they were process evaluations only. Based on our review, our updated model suggests that campaign exposure can lead to individual behavior change and improved health outcomes, either through a direct or indirect pathway. Indirect pathways include exposure through social and policy changes. "Engagement" is positioned as critical to success, replacing awareness in the traditional HOE, and all types of engagement are treated as equal and good. No consideration is being given to potential negative engagement, such as the distribution of misinformation. Additionally, the process is no longer linear and sequential, with circular pathways evident, such as engagement not only influencing behavior change but also generating additional exposure to campaign messages.

CONCLUSIONS

Our review has highlighted a change in conventional understandings of how campaigns can influence health outcomes in the age of social media. The updated model we propose provides social media campaigners with a starting point to develop and tailor campaign messages and allows evaluators to identify critical assumptions to test, including the role and value of "engagement."

TRIAL REGISTRATION

PROSPERO CRD42021287257; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287257.

School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.

Social Media–Based Interventions for Health Behavior Change in Low- and Middle-Income Countries: Systematic Review

Background

Despite the wealth of evidence regarding effective health behavior change techniques using digital interventions to focus on residents of high-income countries, there is limited information of a similar nature for low- and middle-income countries.

Objective

The aim of this review is to identify and describe the available literature on effective social media–based behavior change interventions within low- and middle-income countries.

Methods

This systematic review was conducted in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, Embase, Elsevier, CINAHL, PsycInfo, and Global Index Medicus, and the final search was conducted on April 6, 2021. We excluded studies published before 2000 because of the subject matter. We included studies that evaluated interventions conducted at least partly on a social media platform.

Results

We identified 1832 studies, of which 108 (5.89%) passed title-abstract review and were evaluated by full-text review. In all, 30.6% (33/108) were included in the final analysis. Although 22 studies concluded that the social media intervention was effective, only 13 quantified the level of social media engagement, of which, few used theory (n=8) or a conceptual model (n=5) of behavior change.

Conclusions

We identified gaps in the settings of interventions, types and sectors of interventions, length of follow-up, evaluation techniques, use of theoretical and conceptual models, and discussions of the privacy implications of social media use.

Trial Registration

PROSPERO CRD42020223572; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223572

A Novel, Scalable Social Media-Based Intervention ("Warna-Warni Waktu") to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial

Background

Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population.

Objective

This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years.

Methods

The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level.

Results

Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022.

Conclusions

This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube.

Trial Registration

ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213

International Registered Report Identifier (IRRID)

PRR1-10.2196/33596

Intention to Practice Exclusive Breastfeeding and its Associated Factors among Female College Students

BACKGROUND: The breastfeeding intention of female students plays an important role in the formation of breastfeeding behavior in the future. Lack of attention to this, both owned by students and those around them, can reduce breastfeeding practices when they become mothers later. Moreover, the process of forming intentions to manifest into behavior takes a long time. Students are considered as an educated group who are expected to be role models in breastfeeding practices in the community. AIM: This study intended to examine the relationship between knowledge, subjective norms, and perceptions (benefits, barriers, and vulnerabilities) toward exclusive breastfeeding intention on female college students of the Public Health department on Universitas Muhammadiyah Surakarta. METHODS: A college basis cross-sectional study was conducted in March 2021. The samples were 187 female students who were willing to participate in the study. The selection of samples using a proportional random sampling technique. Data were collected online questionnaires through an online survey platform. A multi logistic regression test was deployed to examine the exclusive breastfeeding intention and its associated factors on a 95% confidence interval. RESULTS: Results show that subjective norm is significantly associated with breastfeeding intention (p < 0.05). Students who had supportive subjective norm twice likely to had the intention to practice exclusive breastfeeding OR value 2.22 95% CI (1.07–4.06). CONCLUSION: Overall, the intention to exclusively breastfed their child was related to the student’s subjective norm. The results of this study have an impact on female students to strengthen their intentions and increase their efforts to plan exclusive breastfeeding when they become mothers. Hence, educational communication is needed to the environment around young women regarding the importance of exclusive breastfeeding so that the social environment can provide support to adolescents in the success of exclusive breastfeeding.

Enabling Better Nutrition and Physical Activity for Adolescents from Middle Eastern Backgrounds: Focus Groups

The obesity epidemic in adolescents from Middle Eastern (ME) backgrounds necessitates co-designed and culturally-responsive interventions. This study's objective was to gather the opinions, attitudes, capabilities, opportunities and motivations of ME adolescents residing in Australia on healthy eating and physical activity (PA) behaviours to inform a future prevention program. Five focus groups were conducted, with 32 ME participants, aged 13-18 years, recruited via purposive and snowball sampling. More participants were female (n = 19) and from lower socioeconomic areas (n = 25). A reflexive thematic analysis was performed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model as the coding framework. Limited nutritional knowledge and cooking skills accompanied by a desire to make dietary changes were reported. Local and school facilities provided adolescents with PA opportunities, but participants declared safety concerns and limited opportunities for females and older grade students. Social support from family and friends were enablers for both healthy eating and PA. Cravings and desire for cultural foods influenced food choices. Individual and/or group approaches using social media and face-to-face format were recommended for future programs. To enable PA and dietary behaviour changes, interventions should be specifically tailored for ME adolescents to improve their nutrition literacy and skills, along with providing safe environments for sport in conjunction with social support.