The effects of Young Adults Eating and Active for Health (YEAH): a theory-based Web-delivered intervention

Components in downstream health promotions to reduce sugar intake among adults: a systematic review

Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.

Physical activity interventions have a moderate effect in increasing physical activity in university students-a meta-analysis

INTRODUCTION

The transition to college is associated with changes in physical activity. This meta-analysis aims to quantify the effect of interventions on increasing physical activity in healthy university students.

METHODS

We conducted a literature search (up to 2/3/2020) to identify randomized controlled trials with healthy undergraduate or graduate students enrolled in a college degree program. Moderator analyses were conducted to examine the effects of intervention modality delivery (delivered in-person or remotely) and the type of outcome measure (self-report or objective measures).

RESULTS

18 publications were included. Interventions had a medium effect on physical activity (Cohen's d = 0.52). Moderator analyses revealed no differences.

CONCLUSION

Suggestions of how to improve the quality of physical activity intervention studies in college students are given. The moderate effect size of physical activity interventions in college students highlights the importance of developing and testing new interventions to promote physical activity in emerging adults.

Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1998070 .

Effectiveness of Online Interventions for the Universal and Selective Prevention of Mental Health Problems Among Adolescents: a Systematic Review and Meta-Analysis

With the emergence of the coronavirus disease 2019 pandemic as a threat to mental health, the demand for online interventions that can replace face-to-face approaches for the prevention of mental health problems is increasing. Although several previous reviews on online interventions have targeted adolescents with symptoms of or those diagnosed with mental illness, there is still a lack of evidence on the effectiveness of online preventive interventions for general and at-risk adolescents. Therefore, this review aimed to evaluate the effectiveness of online interventions on the prevention of an increase in the scores of stress, anxiety, and depression in general and at-risk adolescents. A search was performed using PubMed, EMBASE, and Cochrane Library CENTRAL. Altogether, 19 studies were included, and 16 studies were used for the meta-analysis. Our results showed that cognitive behavioral therapy and family-based interventions were most commonly used. Twelve and seven studies conducted universal and selective preventive interventions, respectively. The meta-analysis showed that online interventions significantly prevent an increase in depression score but not in stress and anxiety scores. Evidence regarding the prevention of increases in stress and anxiety scores is limited, suggesting the need for further randomized controlled trials on online interventions for stress and anxiety in adolescents.

The Effectiveness of E-Health Interventions Promoting Physical Activity and Reducing Sedentary Behavior in College Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Insufficient physical activity (PA) and excessive sedentary behavior (SB) are detrimental to physical and mental health. This systematic review and meta-analysis aimed to identify whether e-health interventions are effective for improving PA and SB in college students. Five electronic databases, including Medline, Web of Science, Embase, Cochrane Library, and ProQuest, were searched to collect relevant randomized controlled trials up to 22 June 2022. In total, 22 trials (including 31 effects) with 8333 samples were included in this meta-analysis. The results showed that e-health interventions significantly improved PA at post-intervention (SMD = 0.32, 95% CI: 0.19, 0.45, p < 0.001) compared with the control group, especially for total PA (SMD = 0.34, 95% CI: 0.10, 0.58, p = 0.005), moderate to vigorous PA (SMD = 0.17, 95% CI: 0.01, 0.32, p = 0.036), and steps (SMD = 0.75, 95% CI: 0.23, 1.28, p < 0.001. There were no significant effects for both PA at follow-up (SMD = 0.24, 95% CI: − 0.01, 0.49, p = 0.057) and SB (MD = −29.11, 95% CI: −70.55, 12.32, p = 0.17). The findings of subgroup analyses indicated that compared to the control group, interventions in the group of general participants (SMD = 0.45, 95% CI: 0.27, 0.63, p < 0.001), smartphone apps (SMD = 0.46, 95% CI: 0.19, 0.73, p = 0.001), and online (SMD = 0.23, 95% CI: 0.04, 0.43, p < 0.001) can significantly improve PA at post-intervention. Moreover, the intervention effects were significant across all groups of theory, region, instrument, duration, and female ratio. At follow-up, interventions in groups of developing region (SMD = 1.17, 95% CI: 0.73, 1.62, p < 0.001), objective instrument (SMD = 0.83, 95% CI: 0.23, 1.42, p = 0.007), duration ≤ 3-month (SMD = 1.06, 95% CI: 0.72, 1.39, p < 0.001), and all female (SMD = 0.79, 95% CI: 0.02, 1.56, p = 0.044) can significantly improve PA. The evidence of this meta-analysis shows that e-health interventions can be taken as promising strategies for promoting PA. The maintenance of PA improvement and the effect of interventions in reducing SB remain to be further studied. Educators and health practitioners should focus on creating multiple e-health interventions with individualized components.

Health behavior interventions for university students measuring mental health outcomes: A scoping review

Introduction

Many university students have poor mental health, and co-occurring health risk behaviors. Targeting health behavior change in this population may improve mental health outcomes. This scoping review describes the extent and range of randomized controlled trials (RCT) evaluating interventions targeting health risk behaviors and measuring a mental health outcome, among university students.

Methods

Six electronic databases were searched for RCTs published until the 18^th May 2021. Eligible RCTs included university students, evaluated interventions that promoted health behavior change (i.e., dietary intake, physical activity, sedentary behavior, alcohol and drug use, smoking, and sleep), and measured a mental health-related outcome.

Results

Fifty-nine RCTs met the inclusion criteria that were published from 2000 to 2021, and over half (n = 33) were conducted in the United States. Interventions evaluated within the RCTs (n = 92) predominantly targeted changes to dietary intake (n = 41 interventions), physical activity (n = 39), or alcohol intake (n = 35). Most interventions targeted one (n = 51) or two (n = 27) health behaviors only. Included RCTs considered mental ill health outcomes (n = 24), psychological wellbeing outcomes (n = 20), or both (n = 15).

Discussion

This scoping review identified a moderate volume of experimental research investigating the impact of health behavior interventions on university students' mental health. There is scope for further research examining health behavior interventions targeting university students, particularly interventions taking a multi-behavioral approach.

Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review

INTRODUCTION

Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality.

METHOD

PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively.

RESULTS

Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed.

DISCUSSION

Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.

Effect of the PRECEDE-PROCEED model on health programs: a systematic review and meta-analysis

BACKGROUND

The predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation policy, regulatory, and organizational constructs in educational and environmental development (PRECEDE-PROCEED) model has been used as a theoretical framework to guide health promotion strategies to prevent chronic diseases and improve the quality of life. However, there is a lack of evidence as to whether applying the PRECEDE-PROCEED model effectively improves health outcomes. This study aimed to systematically review intervention studies that applied the PRECEDE-PROCEED model and examine its effectiveness.  METHODS: In December 2020, seven databases were systematically searched. The quality of studies was assessed using the Mixed Methods Appraisal Tool. The outcome of interest for the meta-analysis was knowledge.

RESULTS

In total, 26 studies were systematically reviewed. Most studies provided educational programs as the main intervention for various population groups. Symptom or disease management and health-related behavior promotion were the most common topics, and education was the most frequently used intervention method. The PRECEDE-PROCEED model was applied in the planning, implementation, and evaluation of the intervention programs. Eleven studies were included in the meta-analysis, which showed that interventions using the PRECEDE-PROCEED model significantly improved knowledge.

CONCLUSIONS

This study indicated that individuals are more likely to engage in health-related behaviors with better knowledge. Thus, the PRECEDE-PROCEED model can be used as the theoretical framework for health promotion interventions across population groups, and these interventions are particularly effective with regard to knowledge improvement.

Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease.

OBJECTIVE

To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation.

DATA SOURCES

MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022.

STUDY SELECTION

Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose.

DATA EXTRACTION AND SYNTHESIS

Independent data abstraction and study quality rating and random effects meta-analysis.

MAIN OUTCOMES AND MEASURES

CVD events, CVD risk factors, diet and physical activity measures, and harms.

RESULTS

One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups.

CONCLUSIONS AND RELEVANCE

Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.

Community-Based Interventions to Reduce Fat Intake in Healthy Populations: A Systematic Review and Meta-Analysis

Background:

Reducing fat intake is a major focus of most dietary recommendations aiming to prevent chronic diseases. Thus, this study aimed to summarize community-based interventions for reducing fat consumption among healthy people.

Methods:

According to PRISMA guidelines, in this systematic review and meta-analysis databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched up to January 2021. Randomized clinical trials (RCTs) or quasi-experimental studies reporting the effect of community-based interventions to reduce fat intake in a healthy populations were included. The quality of studies was assessed using the Cochrane Collaboration tool and The Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was performed using CMA2 software.

Results:

Our search strategy resulted in a total of 1,621 articles, 43 of which were included in the study after screening. Of the 43 included studies, 35 studies reported a significant decrease in fat intake using educational and multiple intervention methods. About 82% of studies using the technology were effective (significant decrease in fat intake) in reducing fat intake. Moreover, studies specifically designed to change fat intake were more effective than multicomponent interventions. The meta-analysis of high-quality studies showed that the differences in total fat (-0.262 g/d) and saturated fat (-0.350 g/d) intake between the intervention and control groups were statistically significant (P<0.05).

Conclusion:

Based on the high-quality studies, educational and multiple interventions are suggested in the community settings to decrease fat intake. For a concise conclusions, long-term and high frequency interventions focusing on reducing fat intake are desirable.

Investigating Web-Based Nutrition Education Interventions for Promoting Sustainable and Healthy Diets in Young Adults: A Systematic Literature Review

Background: Our current rapidly growing food systems are imposing a heavy burden on both environmental sustainability and human health. Sustainable and healthy diets aim to promote optimal health and have a minimal environmental impact. This study aimed to critically review and synthesise the evidence on the effectiveness of web-based nutrition education interventions aiming to promote sustainable and healthy diets among young adults. Methods: A systematic search of four databases (Medline, PsycINFO, Scopus, and Embase) was conducted in March 2021. Studies were included if they used an online platform to deliver the intervention to young adults and measured at least one aspect of sustainable and healthy diets, such as plant-based food intake, food waste, and local and seasonal produce. Of the 2991 studies, a total of 221 full-text articles were assessed for eligibility of which 22 were included in the final review. Results: A majority of the studies (82%) targeted fruit and vegetable consumption, and close to a quarter of studies (23%) targeted other aspects of a sustainable and healthy diet, such as red meat intake. Only one study included multiple aspects of a sustainable and healthy diet. Program delivery outcomes reported overall positive feedback and engagement. Conclusion: This review suggests that web-based interventions may be effective in promoting some sustainable diet-related outcomes in young adults. However, there is a need for developing and evaluating future programs to promote sustainable diets more comprehensively in order to help young adults make healthy and sustainable food choices.

Digital Health Promotion and Prevention in Settings: Scoping Review

BACKGROUND

Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings.

OBJECTIVE

This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps.

METHODS

The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting-based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace.

RESULTS

From 8888 records, the search resulted in 200 (2.25%) included publications. We identified a huge diversity of literature regarding digital setting-based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5%) and neighborhoods or communities (24/200, 12%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5%), nutrition (45/200, 22.5%), and sexual health (34/200, 17%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention.

CONCLUSIONS

The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings.

Shifting From Tokenism to Meaningful Adolescent Participation in Research for Obesity Prevention: A Systematic Scoping Review

Background: Traditionally, adolescent participation in research has been tokenistic. Adolescents are rarely afforded the opportunity to influence decision-making in research designed to prevent obesity. Engaging adolescents in meaningful decision-making may enhance research translation. This review aimed to analyze the current modes and nature of adolescent participation in obesity prevention research decision-making. Methods: A systematic scoping review was conducted using Arksey and O'Malley's six-stage framework. Six major databases were searched for peer-reviewed primary research studies with adolescent participation related to obesity, physical activity, and diet. Modes of adolescent participation were categorized based on the Lansdown-UNICEF conceptual framework for measuring outcomes of adolescent participation. The framework outlines three modes of meaningful participation: (i) consultative, which involves taking opinions and needs into consideration; (ii) collaborative, where adolescents are partners in the decision-making process; and (iii) adolescent-led participation where adolescents have the capacity to influence the process and outcomes. The degree of involvement in research cycles was classified based on the National Health and Medical Research Council consumer engagement framework. Five stages of the research cycle were determined: identify, design and develop, conduct, analyze and disseminate. Results: In total, 126 papers describing 71 unique studies were identified. Of these, 69% (49/71) took place in the USA, and 85% (52/61) were conducted in minority or underserved communities, while males were more likely to be under-represented. In 49% (35/71) of studies, participation was consultative and 9% (6/71) of studies involved an adolescent-led approach. Furthermore, 87% (62/71) of studies incorporated adolescent participation in one or more of the research cycle's formative phases, which involve eliciting views, opinions and idea generation. Only 11% of studies engaged adolescents in all five stages of the research cycle where adolescents could have more influence over the research process. Conclusion: Meaningful adolescent participation in the obesity prevention research cycle is limited. Empowering and mobilizing equal partnership with adolescents should be at the forefront of all adolescent-related obesity prevention research.

Disordered eating concerns, behaviors, and severity in young adults clustered by anxiety and depression

OBJECTIVES

Little is known about how anxiety and depression in combination relate to eating disorder concerns (eating, shape, and weight concern) and behaviors (restraint eating, binge eating, and purging) indicative of eating disorder symptom severity. This study examined links among disordered eating concerns, behaviors, and severity clustered by depression and anxiety.

METHODS

College students (n = 1792) completed a survey comprised of the Generalized Anxiety Disorder Scale (GAD-7), 2-item Patient Health Questionnaire (PHQ-2) assessing Major Depressive Disorder (MDD), and Eating Disorder Exam Questionnaire (EDE-Q) assessing concerns and behaviors indicative of disordered eating.

RESULTS

Cluster analysis yielded four groups: not depressed or anxious to subclinical, moderate, and high depression and anxiety. Analysis of variance (ANOVA) indicated overall eating disorder severity scores increased significantly as GAD and MDD increased, suggesting that as anxiety and depression rise in tandem, disturbed eating severity rises. Results revealed that even at subclinical levels, disordered eating concerns, behaviors, and overall severity scores increase.

DISCUSSION

Future interventions aiming to reduce disordered eating in young adults may be strengthened by incorporating depression and anxiety management strategies. A screening for subclinical anxiety and depression (Mixed Anxiety and Depression Disorder [MADD]) may be helpful in providing early intervention to resolve disordered eating behaviors before they become entrenched.

The Application of Systems Science in Nutrition-Related Behaviors and Outcomes Implementation Research: A Scoping Review

Use of systems science can improve the dissemination and implementation (D&I) process. However, little is known about use of systems science in nutrition D&I research. The purpose of this article is to synthesize the ways in which systems science methodology is applied in nutrition D&I research. Scoping review methodology involved searching 6 academic databases for full-text, peer-reviewed, English articles published between 1970 and 2020 that employed systems science within nutrition D&I research. Data extraction included intervention type, population, study aim, methods, theoretical approach, outcomes, and results. Descriptive statistics and qualitative thematic analysis followed. Thirty-four retained articles qualitatively identified benefits (successful planning and organization of complex interventions) and challenges (limited resources, trainings, and lack of knowledge) to utilizing systems science in nutrition D&I research. Future research should work toward building knowledge capacity among nutrition practitioners by increasing available trainings and resources to enhance the utilization of systems science in nutrition D&I research.

A Systematic Review of Psychosocial Nutrition Interventions for Young Adults

INTRODUCTION

Few have examined the effects of psychosocial nutrition interventions targeting young adults, a population with low fruit and vegetable (FV) consumption. This study investigated the impact of nutrition interventions with psychosocial content on improving young adult FV intake.

METHOD

This registered systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses.

RESULTS

Searches on CINAHL, Embase, Medline PubMed, Ovid-Medline, PsychInfo, and Web of Science identified 4,113 records. Twenty-four randomized controlled trials were extracted. Eighteen studies found significant between-group differences in fruit and/or vegetable intake. Young adults with low income and racial-ethnic subgroups were underrepresented. A typology emerged as an organizing framework from the psychosocial intervention content. Interventions were anticipatory, socially engaged, a hybrid (anticipatory and socially engaged), or exposure-based. Studies also reported unintended consequences.

DISCUSSION

Significant between-group differences were mostly reported by anticipatory, socially engaged, or hybrid interventions, aligning with young adult developmental needs through detailed planning, goal-setting tasks, and/or addressing social norms. Interventions with insignificant differences lacked engagement and adequate exposure.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Demographically inclusive studies are imperative in addressing dietary disparities by socioeconomic status. A typology of interventions emphasizing content rather than theories or treatment strategies widens opportunities for interdisciplinary collaboration. More research is needed to mitigate unintended consequences (boomerang effects) in which FV intake decreased postintervention or participants disengaged in activities intended to increase FV intake.

An incentive-based health program using MyPlate: a pilot study analyzing college students' dietary intake behavior

Is dietary education, incentivized by financial rewards, effective in achieving improved dietary intake behavior of college students? Participants: Fifty-seven undergraduates (18-24 years old), non-nutrition major students. Methods: The intervention group participated in weekly nutrition education meetings which focused on MyPlate for four weeks. Both the control and the intervention groups completed two online surveys that assessed the students' knowledge and dietary behavior at the beginning and at the end of the 4-week education program. The respondents' diet quality was determined by their compliance with MyPlate and their Healthy Eating Index's recommendations. Results: Students who received education showed the most improvement regarding their knowledge and dietary behavior. These respondents tripled their average per capita consumption of whole grains and increased their fruit and vegetable intakes. Conclusions: Educating college students to work toward improving their diets with the assistance of incentives may have positive effect on their health behaviors.

Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature

OBJECTIVE

To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies.

DESIGN

A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up.

RESULTS

From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to evaluate whether individual recruitment strategies met sample size goals, with 77 % successfully achieving recruitment targets. Reporting for retention was slightly better with 69 % of studies providing sufficient information to determine whether individual retention strategies achieved adequate retention rates. Of these, 65 % had adequate retention.

CONCLUSIONS

This review highlights poor reporting of recruitment and retention information across trials. Findings may not be applicable outside a university setting. Guidance on how to improve reporting practices to optimise recruitment and retention strategies within young adults could assist researchers in improving outcomes.

Effectiveness of interventions and behaviour change techniques for improving physical activity in young adults: A systematic review and meta-analysis

Physical activity (PA) participation declines from adolescence to young adulthood. This review evaluates the effectiveness of interventions aiming to improve PA among healthy young adults (17-35 years), and the effectiveness of the behaviour change techniques (BCTs) used. Six electronic databases were searched up to December 2019, for randomized controlled trials aiming to achieve PA behaviour change among young adults. In total, 66 RCTs were included. Meta-analyses for moderate-vigorous PA (n = 11 studies), steps (n = 5 studies) and total PA (MET min/week, n = 11 studies) identified that intervention participants compared with control significantly increased PA at time points up to 3 months and >3 months. Narrative synthesis identified that 34 RCTs (52%) reported significant between group differences favouring the intervention for one or more PA outcome. BCTs with the highest effectiveness were material reward, valued self-identity and habit formation. However, the overall test of significance demonstrated no significant relationship between type or number of BCTs and effectiveness. This review identified interventions that improve steps, moderate-vigorous and total PA in young adults in the shorter-term, and BCTs associated with greater effectiveness. Further research is needed to determine strategies to achieve longer-term effectiveness of PA interventions in young adults.

Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review

OBJECTIVES

The purpose of this review was to use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to assess the extent to which weight gain prevention studies targeting young adults reported on elements of external validity.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Articles of interest included a lifestyle/behavioral intervention targeting weight gain prevention. Eligibility criteria included the following: study design of randomized controlled trials, quasi-randomized control trials, or natural experiments; average participant age between 18 and 35 years; study duration of at least 12 months; and published in English between January 2008 and May 2018. Studies had to report weight or body mass index as a measured outcome and were excluded if they were paired with smoking cessation programs, were conducted in specific groups (ie, pregnant women, breast cancer survivors), or were follow-ups to weight loss studies.

STUDY SELECTION

After removing duplicates, the search yielded 11426 articles. Titles and abstracts were screened by 1 reviewer; 144 articles were assessed in a full-text review by 2 reviewers. Discrepancies were resolved by consensus. Nine studies (13 articles) were included in the review.

MAIN OUTCOMES MEASURES

Reported elements of the RE-AIM framework.

RESULTS

A total of 9 studies met the selection criteria. All studies lacked full reporting on external validity elements. Of the total of 60 RE-AIM reporting criteria, 8 were reported by all 9 studies, 26 criteria were reported by fewer than 4 studies, and 22 criteria were not reported by any of the studies.

DISCUSSION

There remains inadequate reporting of elements of external validity and generalizability in weight gain prevention studies. This is a significant scientific constraint that limits the information required to disseminate and implement prevention of weight gain interventions for population impact. Standardized reporting may be needed to ensure results that demonstrate not only internal validity but also external validity and generalizability are needed to promote public health impact.

The food choices of US university students during COVID-19

COVID-19 triggered widespread disruption in the lives of university students across the United States. We conducted 9 online focus groups with 30 students from a large public university to understand the impact of COVID-19 on the food choices of those displaced from their typical residences due to the pandemic. To the authors' knowledge, this is the first qualitative research to examine the changes in food choice for US university students due to COVID-19 and offer insight into why these changes occurred. Students in this study reported significant, and often negative, changes in food choices during the pandemic compared to when on campus. Many students described changes in the foods they ate, the amount consumed, and increased snacking behaviors. We found food availability and household roles to be powerful factors influencing food choices. Most students had returned to family homes with many students taking a passive role in activities that shape food choices. Parents usually purchased groceries and prepared meals with students eating foods made available to them. Increased free time contributed to boredom and snacking for some students, while for a few students with increased skills and/or agency, additional free time was used to plan and prepare meals. About a third of the students attributed eating different foods at home to food availability issues related to the pandemic such as groceries being out of stock, purchasing non-perishable foods, or the inability to get to a store. This information may be helpful to researchers and health promotion professionals interested in the effects of COVID-19 on student nutrition and related food behaviors, including those interested in the relationship between context and food choice.

The Promotion of Eating Behaviour Change through Digital Interventions

Diet-related chronic disease is a global health epidemic giving rise to a high incidence of morbidity and mortality. With the rise of the digital revolution, there has been increased interest in using digital technology for eating behavioural change as a mean of diet-related chronic disease prevention. However, evidence on digital dietary behaviour change is relatively scarce. To address this problem, this review considers the digital interventions currently being used in dietary behaviour change studies. A literature search was conducted in databases like PubMed, Cochrane Library, CINAHL, Medline, and PsycInfo. Among 119 articles screened, 15 were selected for the study as they met all the inclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search strategy. Four primary digital intervention methods were noted: use of personal digital assistants, use of the internet as an educational tool, use of video games and use of mobile phone applications. The efficiency of all the interventions increased when coupled with tailored feedback and counselling. It was established that the scalable and sustainable properties of digital interventions have the potential to bring about adequate changes in the eating behaviour of individuals. Further research should concentrate on the appropriate personalisation of the interventions, according to the requirements of the individuals, and proper integration of behaviour change techniques to motivate long-term adherence.

Beyond Body Weight: Design and Validation of Psycho-Behavioural Living and Eating for Health Segments (LEHS) Profiles for Social Marketing

Obesity, sedentary behaviour, and poor dietary habits amongst young adults are growing concerns, with this age group being in a worse state of health and nutrition than adolescents and adults. This paper presents the procedures for establishing a new instrument for defining behaviours in relation to healthy lifestyle and food choices amongst young adults (Living and Eating for Health Segments: LEHS). The aim of this paper is to outline the instrument design protocol for external validation and to permit replication in other studies. The instrument design process used a multi-step social marketing instrument design method. This approach has previously been used in designing valid and reliable measures in marketing and consumer research, including social marketing. The protocol established six psycho-behavioural LEHS profiles for young adults. These profiles are: Lifestyle Mavens (15.4%), Aspirational Healthy Eaters (27.5%), Balanced-all Rounders (21.4%), Health Conscious (21.1%), Contemplating Another Day (11.2%), and Blissfully Unconcerned (3.4%). Each of these profiles provided insights into psycho-behavioural characteristics that can be used in designing apposite social media social marketing campaigns.

Strategies and Measurement Tools in Physical Activity Promotion Interventions in the University Setting: A Systematic Review

The university environment is especially suitable for implementing health promotion interventions and specifically for physical activity promotion among university students. The objective of this systematic review was to describe the strategies employed and the physical activity data collection tools that have been used in said interventions. A systematic search for articles was conducted using the PubMED, Cochrane, and PEDro databases. The articles selected were those describing a physical activity promotion intervention aimed at university students in their own university setting in which there was a control group. Eventually, 1074 articles were identified, of which 13 fulfilled the selection criteria. The results show eight strategies and nine different instruments for collecting physical activity data. The strategies identified were used in combination and they were adapted in each of the complex interventions. Validated questionnaires were the most widely used instrument. Future original studies are needed to find out the impact of these strategies in physical activity promotion among university students specifically in the university context.

Effectiveness of gender-targeted versus gender-neutral interventions aimed at improving dietary intake, physical activity and/or overweight/obesity in young adults (aged 17-35 years): a systematic review and meta-analysis

BACKGROUND

Young adulthood has become synonymous with the development of poor lifestyle behaviours associated with an increased risk of preventable chronic disease in later years. Interventions aiming to improve health behaviours may be more engaging and effective if they are targeted to males or females than interventions with a gender-neutral approach. This review will examine the outcome effectiveness of gender-targeted and gender-neutral interventions targeting nutrition, physical activity or overweight/obesity in young adults (17-35 years).

METHODS

Six electronic databases were searched for randomised controlled trials (RCTs) published up to December 2019 that evaluated nutrition, physical activity and/or overweight/obesity interventions in young adults (17-35 years). An effective intervention was one where the change in one or more primary outcome was positive and statistically significantly different from baseline, compared with control, or if no control comparator, compared with another active intervention. Effectiveness of outcomes was compared between gender-targeted and gender-neutral studies.

RESULTS

In total 21,582 manuscripts were identified and 107 RCTs were included; 30 gender-targeted studies (28%) and 77 gender-neutral (72%). Most gender-targeted studies were female targeted (n = 22, 73%). Primary outcome/s were adiposity (n = 36, 34%), nutrition (n = 29, 27%), physical activity (n = 28, 26%), or a combination of (n = 14, 14%). A greater proportion of gender-targeted than gender-neutral studies were effective in improving nutrition (n = 6, 100% and n = 17, 74% of studies respectively) and physical activity outcomes (n = 6, 86% and n = 14, 67% respectively), where as a greater proportion of gender-neutral studies were effective in improving adiposity outcomes (n = 13, 59% and n = 5, 36% respectively). None of these differences were statistically significant. Meta-analyses for weight found no significant differences between gender-targeted and gender-neutral studies for weight loss or weight gain prevention studies. Meta-analysis for fruit and vegetable intake demonstrated a significantly greater increase in intervention participants in gender-targeted studies of +158 g/day for > 3 months.

CONCLUSIONS

Although differences in outcome effectiveness were identified between gender-targeted and gender-neutral studies, these were not significantly different. This is likely due to an insufficient number of studies to detect a difference. The meta-analysis for fruit and vegetable intake findings should be interpreted with caution due to including only two gender-targeted studies. The findings collectively are suggestive of a potential difference requiring further investigation. To truly determine the effectiveness of gender-targeted interventions, well-designed RCTs comparing gender-targeted interventions with gender-neutral and control are needed.

REGISTRATION

This systematic review is a secondary analysis of studies included in a systematic review examining the effectiveness of interventions targeting nutrition, physical activity, or overweight/obesity in young adults, for which a predefined protocol was registered with PROSPERO (CRD42017075795).

Review of the Scientific Literature on Young Adults Related to Cardiovascular Disease Intervention

Many young adults are at risk for cardiovascular disease related to their behavioral choices. Irresponsible alcohol consumption, tobacco smoking, sedentary lifestyle, poor dietary habits, and excessive weight gain are some of the behaviors that put young adults at risk. The Centers for Disease Control and Prevention identified that 15% of young adults are diagnosed with chronic illnesses related to their behavioral choices. The purpose of this review is to identify, in the literature, interventions that are currently available to young adults and evaluate the adequacy and effectiveness of those interventions. An extensive electronic search was conducted using CINAHL, EBSCOhost, Cochrane, PubMed, and Google Scholar. A total of 130 articles were identified and 28 articles met the inclusion criteria. Three main interventions were identified for young adults: personalized interventions, technology-based interventions, and educational/behavioral interventions. The interventions were all effective to different degrees and interventions were most effective when they were combined. This review impacts in what manner nurses and health care providers deliver health promotion, prevention, and management of cardiovascular risk factors in young adults; in particular, nurses play a key role in lifestyle modifications including diet and exercise.

Community-Based Prevention Programs for Disordered Eating and Obesity: Updates and Current Limitations

PURPOSE OF REVIEW

To review the status of community-based disordered eating and obesity prevention programs from 2014 to 2019.

RECENT FINDINGS

In the last 5 years, prevention programs have found success in intervening with children and parental figures in wellness centers, physical activity centers, childcare centers, workplaces, online, and over-the-phone through directly reducing disordered eating and obesity or by targeting risk factors of disordered eating and obesity. Community-based prevention programs for disordered eating and programs targeting both disordered eating and obesity were scarce, highlighting the critical need for the development of these programs. Qualities of the most effective programs were those in which parents and children were educated on physical activity and nutrition via multiple group-based sessions. Limitations of current prevention programs include few programs targeting high-risk populations, a dearth of trained community members serving as facilitators, inconsistent reporting of adherence rates, and few direct measurements of disordered eating and obesity, as well as few long-term follow-ups, precluding the evaluation of sustained effectiveness.

Which behaviour change techniques within interventions to prevent weight gain and/or initiate weight loss improve adiposity outcomes in young adults? A systematic review and meta-analysis of randomized controlled trials

Young adulthood is associated with the highest rate of weight gain compared with any other adult age group. This review evaluates the effectiveness of interventions with adiposity outcomes among young adults and identifies which behaviour change techniques (BCTs) are most effective. BCT utilization was assessed using Michie's 93-item BCT Taxonomy v1. Six electronic databases were searched for randomized controlled trials assessing change in adiposity in young adults (17-35 years) until December 2019; identifying 21,582 articles. Fifty-one studies were included. Meta-analyses for weight (n=19 studies), body mass index (BMI) (n=20 studies), and waist circumference (n=10 studies) demonstrated no significant between-group differences at ≤3 or >3 months. There were no differences between interventions focusing on weight loss or weight-gain prevention. Narrative synthesis showed significant between-group differences in weight change, favouring the intervention in 14/43 (33%) studies. In studies assessing BMI and waist circumference, this was 31% (11/36) and 25% (4/16). Two BCTs had a percentage effectiveness ratio >50% in weight loss interventions; social support (unspecified) and self-monitoring behaviour, and one in weight-gain prevention interventions; and goal-setting (outcome). Findings demonstrate initial potential for these types of BCTs and can help build cumulative evidence towards delivering effective, cost-efficient, and replicable interventions.

The efficacy of electronic health interventions targeting improved sleep for achieving prevention of weight gain in adolescents and young to middle-aged adults: A systematic review

Sleep is emerging as a modifiable risk factor in counteracting harmful weight gain. Electronic and mobile devices offer a channel for wide-reaching intervention delivery. This systematic review aimed to determine the efficacy of interventions that included sleep behaviour as part of health promotion for preventing weight gain. Seven databases were searched from 1 January 2000 until 28 June 2019. Eligible studies were controlled trials of weight gain prevention programs that addressed sleep in healthy participants aged 13 to 44 years of age. The primary outcome was change in measured or self-reported weight. From 824 publications located, only six eligible trials with a total of 3,277 participants were identified and all addressed multiple behaviours. One study demonstrated a decrease in weight for the intervention group, and two other studies showed a decreased prevalence of overweight and obesity. Only one trial showed improved sleep duration but failed to show differences in weight. No definitive conclusions concerning the efficacy of electronic weight gain prevention interventions that include sleep can be made, but future trials should provide more detail about intervention techniques used, employ objective sleep and physical activity measures and undertake mediation analysis to judge the contributions of changes in sleep to study outcomes. PROSPERO REGISTRATION: CRD42019121879.

Factors that contribute to effective online nutrition education interventions: a systematic review

CONTEXT

The use of the internet and technology as a medium for delivering online nutrition education (ONE) has increased; however, evidence-based studies exploring factors that contribute to best practices in online interventions have not emerged.

OBJECTIVE

The purpose of this systematic review was to identify factors that contributed to successful ONE interventions in relation to research studies published between 2009 and 2018.

DATA SOURCES

Following the PRISMA guidelines, relevant studies were identified through PubMed, Medline, Web of Science, Science Direct, and Education Resources Information Center (ERIC) databases.

DATA EXTRACTION

Five authors screened and determined the quality of the studies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and extracted the data from the articles.

DATA ANALYSIS

Twenty-seven studies were included: 21 studies were website-based, 3 were delivered through smartphone application, 2 were delivered as online courses, and 1 used text messages. Tailored messages/feedback, interaction between participants and investigators, identification of specific behaviors, use theory, adequate duration, and alignment between stated objectives and activities were factors that contributed to successful online interventions, while comparison bias and the lack of specific details on duration and dosage, tracking system, objective outcome measurements, and follow-up were factors that may have interfered with successful ONE interventions.

CONCLUSIONS

The findings underscore the importance of developing ONE intervention designs that utilize factors unique to online platforms for effective interventions aimed at behavior change.

A Multi-Year Examination of Gardening Experience and Fruit and Vegetable Intake During College

Gardening has been positively associated with fruit and vegetable (FV) consumption based on short-term studies among children, but long-term data among adolescents and young adults are lacking. This investigation sought to elucidate the association between gardening experience and FV intake among college students over a two-year period. Students (N = 593) from eight universities were assessed at the end of their freshman (Y1) and sophomore (Y2) years during the springs of 2016 and 2017, respectively. At each time point, participants completed the NCI FV Screener and questions related to gardening experience and FV-related attitudes and behaviors. Students were then categorized into four groups based on gardening experience: Gardened only during the first or second year (Y1 only and Y2 only gardeners), gardened both years (Y1+Y2 gardeners), and non-gardeners. While both Y1 only and Y1+Y2 gardeners reported significantly higher FV intake relative to non-gardeners at Y1 (2.3 ± 0.9 and 2.6 ± 0.7 versus 1.9 ± 0.6 cup equivalents (CE)/day, respectively; p < 0.01), only Y1+Y2 gardeners differed from non-gardeners at Y2 (2.4 ± 0.6 versus 1.8 ± 0.5 CE/day; p < 0.001). Additionally, Y1+Y2 gardeners reported more frequent engagement of several FV-related behaviors, including shopping at farmers’ markets, eating locally grown foods, and cooking from basic ingredients; and were five times more likely to have gardened during childhood (OR: 5.2, 95%, CI: 3.5–8.8; p < 0.001). Findings suggest that while isolated gardening experiences during college are associated with FV intake, reoccurring experience may be essential for sustained benefit.

Types of Interventions Targeting Dietary, Physical Activity, and Weight-Related Outcomes among University Students: A Systematic Review of Systematic Reviews

A plethora of studies aiming to improve dietary, physical activity (PA), and weight-related (WR) outcomes among university students have been implemented and summarized in a series of systematic reviews, with unclear conclusions regarding their effectiveness. This overview aims to identify systematic reviews and meta-analyses of studies aiming to improve health outcomes in university students, to assess their methodological quality, to identify the different types of interventions used and outcomes assessed, and to estimate their overall effect. Four electronic databases were searched until 19 March, 2018 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The identified reviews were described and their methodological quality was rated. The studies of reviews were investigated to identify the different types of interventions used and outcomes assessed. Effectiveness was assessed by measuring the overall number of improved outcomes out of the total number of outcomes reported. As a result, 8 reviews were identified targeting food sales (n = 2), dietary (n = 3), PA (n = 1), WR (n = 1), or all outcomes (n = 1). The methodological quality of the reviews was moderate (n = 5) to low (n = 3). In all, the reviews included 122 studies, of which 36 used an environmental, 51 a face-to-face, 30 an e-intervention, and 5 a combined approach. Environmental interventions improved a moderate number of food sales (32 of 61) and dietary intake (22 of 47) outcomes. Face-to-face interventions improved a high number of dietary cognitive outcomes (15 of 18), a moderate number of dietary intake (28 of 65) and WR (11 of 18) outcomes, and a low number of PA behavioral (22 of 69) and cognitive (2 of 14) outcomes. E-interventions improved a high number of dietary cognitive variables (11 of 16) but had a low effect (≤33%) on the other types of outcomes. In conclusion, face-to-face and e-interventions improved cognitive variables toward diet or PA but were less effective in changing actual behaviors. Environmental interventions favorably changed food sales. Face-to-face and e-interventions moderately affected WR outcomes. Future research should focus on long-term studies.

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students' label-reading skills and healthy food choices, before they settle into grocery shopping habits.

Reported theory use in electronic health weight management interventions targeting young adults: a systematic review

This review assesses the extent of reported theory use in electronic health weight management interventions targeting young adults aged 18-35 years. Twenty-four eligible studies were identified. Two independent reviewers extracted data and coded for theory use using the Theory Coding Scheme. Overall, the mean total use of theory score was 6/23 (SD = 5; Min. = 0, Max. = 17); 17 studies were classified as having weak application of theory, five as moderate, and two as strong. The majority (N = 18) of studies mentioned theory, however, most (N = 14) did not report how intervention techniques related to theoretical base. No study used theory to select intervention recipients and only four used theory to tailor intervention techniques to recipients. Limited studies reported theory testing (N = 6) and no study used intervention results to build and/or refine theory. Results indicate that weight-related outcomes may be enhanced when at least one or more theoretical constructs are explicitly linked to an intervention technique and when theoretical constructs are included in evaluations. Increases in theory application and reporting are needed to assist the scientific research community in systematically identifying which theories work, for whom, how, why, and when; thereby delivering an advanced understanding of how best to apply theory to enhance intervention outcomes.

Development of the Top Tips Habit-Based Weight Loss App and Preliminary Indications of Its Usage, Effectiveness, and Acceptability: Mixed-Methods Pilot Study

BACKGROUND

The Ten Top Tips (10TT) is an intervention based on the habit formation theory that promotes a set of weight management behaviors alongside advice about repetition in a consistent context. Overall, 3 studies have demonstrated that the 10TT can support individuals to lose weight when delivered in a leaflet format. Delivery of 10TT via new technology such as a mobile app could potentially improve its effectiveness and make it more convenient, appealing, and wide reaching.

OBJECTIVE

This study aimed to provide preliminary indications of the usage, effectiveness, and acceptability of an Android app of the 10TT intervention (Top Tips only app) and a second version including self-regulatory strategies for dealing with tempting foods (Top Tips plus app).

METHODS

The 3-month pilot randomized adults with overweight or obesity to (1) Top Tips only app, (2) Top Tips plus app, or (3) waiting list condition. Automated data from app users were collected. Validated questionnaires assessed self-regulatory skills, weight loss (kg), and behaviors at baseline and 3 months. Users' feedback on their experience using the app was assessed using open questions.

RESULTS

A total of 81 participants took part in the pilot; 28 participants were randomized to the Top Tips only app, 27 to the Top Tips plus app, and 26 to the waiting list condition. On average, participants viewed a mean of 43.4 (SD 66.9) screens during a mean of 24.5 (SD 44.07) log-ins and used the app for 124.2 (SD 240.2) min over the 3-month period. Participants randomized to the Top Tips only app reported the greatest improvement in self-regulatory skills (mean 0.59, SD 1.0), weight loss (mean 4.5 kg, SD 5.2), and adherence to the target behaviors (mean 0.59, SD 0.49) compared with the Top Tips plus (meanself-regulation 0.15, SD 0.42; meanweight -1.9, SD 3.9; and meanbehaviors 0.29, SD 0.29) and waiting list condition (meanself-regulation -0.02, SD 0.29; meanweight -0.01, SD 0.51; and meanbehaviors 0.08, SD 0.38). Participants who reported the largest improvements, on average, viewed pages 2 to 3 times more, had 2 to 3 times more log-ins, logged their weight 2 to 3 times more, and achieved the tips more than those who reported smaller changes in these outcomes. According to users' feedback, engagement with the app could be increased by making the app more interactive and allowing more tailoring.

CONCLUSIONS

This study suggests that the Top Tips app could potentially be a useful intervention for promoting eating self-regulatory skills, weight loss, and weight management behaviors among adults with overweight or obesity. Future research should develop the app further based on user feedback and test it in larger sample sizes.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN10470937; http://www.isrctn.com/ISRCTN10470937 (Archived by Webcite at http://www.webcitation.org/76j6rQibI).

Effectiveness of Interventions and Behaviour Change Techniques for Improving Dietary Intake in Young Adults: A Systematic Review and Meta-Analysis of RCTs

Poor eating habits are common during young adulthood and influence chronic disease morbidity. This systematic review evaluates the effectiveness of interventions aiming to improve dietary intake among young adults and, identifies which behaviour change techniques (BCTs) are most effective. Six electronic databases were searched for RCTs published until October 2018, and evaluating behavioural interventions assessing change in dietary intake in young adults (17–35 years). Of the 18,779 articles identified, 54 were included. Forty studies focused on fruit and/or vegetable intake, of which 63% showed a significant between-group difference in favour of the intervention group. Meta-analysis (n = 17) demonstrated a significant increase in fruit and vegetable intake of +68.6 g/day after three months of intervention and +65.8 g/day for interventions >3 months when compared to control. A meta-analysis (n = 5) on total energy intake found no significant differences between groups. The BCTs with the highest effectiveness ratio were habit formation (100%), salience of consequences (83%) and adding objects to the environment (70%). The review highlights the potential of behavioural interventions to improve young adults’ fruit and vegetable intake but was less convincing for other dietary outcomes. Due to the lack of studies including each BCT, the BCTs imperative to success could not be identified.

A Brief Web-Based Nutrition Intervention for Young Adult University Students: Development and Evaluation Protocol Using the PRECEDE-PROCEED Model

Background

Young adults are a priority population for nutrition interventions because of the high prevalence of unhealthy eating behaviors, high risk of weight gain, and the importance of this life stage for developing lifelong eating behaviors. Innovative intervention strategies are needed to reach and engage young adults, whereas more detailed reporting of intervention development and testing would facilitate progress in this challenging research area.

Objective

This paper describes the development of the EATS (Eating Advice To Students) intervention, a targeted, brief Web-based nutrition intervention for young adult (17 to 35 years) university students, and describes the pilot randomized controlled trial (RCT) to assess intervention feasibility.

Methods

EATS was developed using the PRECEDE-PROCEED model. The development involved a cross-sectional survey of university students’ eating behaviors and determinants, a systematic review of brief nutrition interventions, and consultation with a project steering committee. EATS was developed as a website with 4 components: (1) brief screening quiz with personalized feedback, (2) provision of information, tips, and strategies for each target eating behavior (consumption of vegetables, fruit, discretionary foods, and breakfast) and 2 guided exercises to facilitate behavior change, (3) goal setting, and (4) creating strategies. A pilot RCT with students from the University of Newcastle, Australia, was conducted from February to July 2018. The students were randomized to EATS or a brief Web-based alcohol intervention (attention control). The process evaluation included intervention acceptability (Web-based survey postintervention completion) and objective usage data (collected in real time). Efficacy data (Web-based survey at baseline and 3 months) included diet quality, consumption of target food groups (eg, fruits and vegetables), alcohol intake, self-efficacy to perform target eating behaviors, and well-being.

Results

Collection of the 3-month follow-up data was completed in July 2018.

Conclusions

EATS presents an innovative solution to many of the difficulties faced in targeting young adults to improve their eating behaviors. Given the strong methodological approach undertaken, this study provides a significant contribution to advance this research area.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618000118202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374365&isReview=true (Archived by WebCite at http://www.webcitation.org/765o5fVwa)

International Registered Report Identifier (IRRID)

DERR1-10.2196/11992

Weight Management in Young Adults: Systematic Review of Electronic Health Intervention Components and Outcomes

Background

Young adulthood is a vulnerable period for unhealthy lifestyle adoption and excess weight gain. Scant attention has been focused on developing and evaluating effective weight gain prevention strategies for this age group. Electronic health (eHealth) offers potential as a cost-effective means of delivering convenient, individually-tailored, and contextually-meaningful interventions at scale.

Objective

The primary aim of this systematic review was to locate and synthesize the evidence on eHealth weight management interventions targeting young adults, with a particular focus on (eHealth) intervention components and outcomes.

Methods

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy was executed across the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EBSCO, EMBASE, Emerald, Education Resources Information Center, Medical Literature Analysis and Retrieval System Online, Ovid, ProQuest, PsycINFO, PubMed, Science Direct, Scopus, and Web of Science. Furthermore, 2 reviewers independently assessed records for eligibility: peer-reviewed, published in English, and report evaluations of eHealth weight management interventions targeting healthy young adults (aged 18-35 years). Data were then extracted from studies that met the criteria for inclusion. The methodological quality of studies was independently assessed by 2 reviewers using the Effective Public Health Practice Project’s (EPHPP) quality assessment tool. A comprehensive narrative evidence synthesis was then completed.

Results

Out of the 1301 studies assessed for eligibility, 24 met the criteria for inclusion. According to the EPHPP quality assessment tool, overall, 19 studies were as rated weak, 5 as moderate, and none as strong. The narrative synthesis of intervention outcomes found 8 studies reported positive weight-related outcomes, 4 reported mixed outcomes, and 12 did not report any significant changes in weight-related outcomes. The narrative synthesis of (eHealth) intervention components led to 3 levels of classification. A total of 14 studies were classified as Web-based, 3 as mobile-based, and 7 as multicomponent interventions. Following the narrative synthesis, 5 key strategies were thematically identified: self-regulation (goal setting and self-monitoring), tailored or personalized feedback, contact with an interventionist, social support, and behavioral prompts (nudges and reminders) and booster messages.

Conclusions

Findings highlight the limited evidence base for eHealth weight management interventions targeting young adults. The complex nature of weight management presents an ongoing challenge for interventionists to identify what works, for whom, how, and when. The quality of the evidence in this review was generally assessed as weak; however, assessment tools such as the EPHPP are principally concerned with what should be and this is seldom equivalent to what works. Thus, while sampling, study design and retention rates will remain key determining factors of reliability and validity, further research attention directed toward the development of guiding tools for community trials is warranted.

User Models for Personalized Physical Activity Interventions: Scoping Review

Background

Fitness devices have spurred the development of apps that aim to motivate users, through interventions, to increase their physical activity (PA). Personalization in the interventions is essential as the target users are diverse with respect to their activity levels, requirements, preferences, and behavior.

Objective

This review aimed to (1) identify different kinds of personalization in interventions for promoting PA among any type of user group, (2) identify user models used for providing personalization, and (3) identify gaps in the current literature and suggest future research directions.

Methods

A scoping review was undertaken by searching the databases PsycINFO, PubMed, Scopus, and Web of Science. The main inclusion criteria were (1) studies that aimed to promote PA; (2) studies that had personalization, with the intention of promoting PA through technology-based interventions; and (3) studies that described user models for personalization.

Results

The literature search resulted in 49 eligible studies. Of these, 67% (33/49) studies focused solely on increasing PA, whereas the remaining studies had other objectives, such as maintaining healthy lifestyle (8 studies), weight loss management (6 studies), and rehabilitation (2 studies). The reviewed studies provide personalization in 6 categories: goal recommendation, activity recommendation, fitness partner recommendation, educational content, motivational content, and intervention timing. With respect to the mode of generation, interventions were found to be semiautomated or automatic. Of these, the automatic interventions were either knowledge-based or data-driven or both. User models in the studies were constructed with parameters from 5 categories: PA profile, demographics, medical data, behavior change technique (BCT) parameters, and contextual information. Only 27 of the eligible studies evaluated the interventions for improvement in PA, and 16 of these concluded that the interventions to increase PA are more effective when they are personalized.

Conclusions

This review investigates personalization in the form of recommendations or feedback for increasing PA. On the basis of the review and gaps identified, research directions for improving the efficacy of personalized interventions are proposed. First, data-driven prediction techniques can facilitate effective personalization. Second, use of BCTs in automated interventions, and in combination with PA guidelines, are yet to be explored, and preliminary studies in this direction are promising. Third, systems with automated interventions also need to be suitably adapted to serve specific needs of patients with clinical conditions. Fourth, previous user models focus on single metric evaluations of PA instead of a potentially more effective, holistic, and multidimensional view. Fifth, with the widespread adoption of activity monitoring devices and mobile phones, personalized and dynamic user models can be created using available user data, including users’ social profile. Finally, the long-term effects of such interventions as well as the technology medium used for the interventions need to be evaluated rigorously.

[Effects of an Integrated Physical Activity Program for Physically Inactive Workers: Based on the PRECEDE-PROCEED Model]

PURPOSE

We aimed to examine the effects of an integrated physical activity (PA) program developed for physically inactive workers on the theoretical basis of the PRECEDE-PROCEED model.

METHODS

Participants were 268 workers in three departments of L manufacturing unit in South Korea. The three departments were randomly allocated into integration (n=86) (INT), education (n=94) (ED), and control (n=88) (CT) groups. The INT group received self-regulation, support, and policy-environmental strategies of a 12-week integrated PA program, the ED group received self-regulation strategies only, and the CT group did not receive any strategies. After 12 weeks, process evaluation was conducted by using the measures of self-regulation (autonomous vs. controlled regulation), autonomy support, and resource availability; impact evaluation by using PA measures of sitting time, PA expenditure, and compliance; and outcome evaluation by using the measures of cardiometabolic/musculoskeletal health and presenteeism.

RESULTS

Among process measures, autonomous regulation did not differ by group, but significantly decreased in the CT group (p=.006). Among impact measures, PA compliance significantly increased in the INT group compared to the CT group (p=.003). Among outcome measures, the changes in cardiometabolic/musculoskeletal health and presenteeism did not differ by group; however, systolic blood pressure (p=.012) and a presenteeism variable (p=.041) significantly decreased only in the INT group.

CONCLUSION

The integrated PA program may have a significant effect on increases in PA compliance and significant tendencies toward improvements in a part of cardiometabolic health and presenteeism for physically inactive workers. Therefore, occupational health nurses may modify and use it as a workplace PA program.

Assessing Physical Activity, Fruit, Vegetable, and Sugar-Sweetened Beverage Intake Patterns of College Students in Kansas

OBJECTIVE

To test the effectiveness of a 15-month intervention for reducing sugar-sweetened beverage (SSB) intake among college students and assess fruit and vegetable (F/V) intake and physical activity (PA) habits and their relationship to SSB intake.

DESIGN

Randomized, controlled study.

PARTICIPANTS

A total of 156 college students (aged 18-24 years) from a Kansas university, mostly female (72%), white (89%), and freshmen (51%).

INTERVENTION

Two-staged intervention included participants receiving: (1) 3 weekly stage-tailored messages on healthful behaviors for 10 weeks; and (2) 3 monthly stage-tailored messages and 1 monthly e-mail encouraging a visit to the portal page, after the 3-month physical assessment.

MAIN OUTCOME MEASURE(S)

Stages of change for PA and F/V intake, self-reported PA scores, self-reported F/V intake, and SSB intake habits.

ANALYSIS

Generalized linear mixed models and linear regression models were used to test changes and associations among outcome measures.

RESULTS

No significant decrease occurred in SSB consumption (P > .05) among intervention participants. Both control and intervention groups recorded low F/V intake and moderate PA scores.

CONCLUSIONS AND IMPLICATIONS

Low F/V intake and high SSB intake evident among study participants may pose risk for unwanted weight gain and obesity-related conditions. Furthermore, college campuses can continue to support an environment conducive for being physically active, while promoting healthy eating behaviors.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores

Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. Results: Controlling for gender, HMI was negatively associated with SSBs (β = −0.859) and %kcal/fat (β = −1.057) and positively with whole-grains (β = 0.186) and fruits/vegetables intake (β = 0.267); %Kcal/fat was positively (β = 0.098) and fruits/vegetables intake (β = −0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (β = 0.214, β = 0.129) and directly/negatively to BMI (β = −2.657, β = −1.124). Conclusions: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

Rationale and Design of an Online Educational Program Using Game-Based Learning to Improve Nutrition and Physical Activity Outcomes Among University Students in the United Kingdom

OBJECTIVE

To assess the impact of an online game-based educational program on nutrition knowledge and dietary and physical activity habits among university students in the United Kingdom.

DESIGN

Randomized controlled trial with pre- and postintervention comparisons.

SETTING

Two higher education settings in London, UK.

SUBJECTS

Current undergraduate and postgraduate students of two universities (n = 88) aged 18-34 years are randomly allocated to an intervention (n = 44) or a control group (n = 44).

INTERVENTION

The intervention group will receive access to an educational website and online quizzes with gamification elements, including information about healthy eating and physical activity. The control group will receive no information. Duration of the intervention will be 10 weeks.

MEASURES OF OUTCOME

Primary outcome is nutrition knowledge. Secondary outcomes include dietary and activity habits. Nutrition knowledge and dietary and activity habits will be assessed using questionnaires. Weekly steps will be counted using pedometers. Assessment of anthropometric and metabolic risk factors will take place.

ANALYSIS

Quantitative analysis will investigate changes in nutrition knowledge between the two groups of the study population. Linear regression analysis will be used, if the data follow the normal distribution (otherwise binomial regression analysis), to examine whether field of study, residence status, body mass index (BMI), and demographic factors affect nutrition knowledge. Associations between changes in knowledge and dietary and physical activity behavior will be assessed by correlations.

CONCLUSIONS/IMPLICATIONS

The study will provide insights with regard to the design and use of online game-playing as a cost-effective approach to improve nutritional knowledge among university students.

Strategies Used for Making Healthy Eating Choices among Veterinary Medical Students

Healthy eating is a challenge for most college students, and students in the field of veterinary medicine are no exception. Health experts have recommended that universities emphasize the importance of healthy eating and promote healthy eating habits among students. However, before we can begin offering targeted interventions to promote healthy eating strategies and behaviors, we must first understand students' current strategies used for making healthy eating choices, self-reported eating habits, and perceptions of diet quality. Thus, the purpose of this study was to understand veterinary medical students' perceptions of current diet quality and to characterize their strategies for making healthy eating choices. Results indicate veterinary medical students employ a wide range of strategies and behaviors for healthy eating, yet few students reported eating a diet of poor quality. We conclude that while most students report eating a relatively healthy diet, variation in strategies used suggests room for improvement for many. This article discusses potential intervention strategies to promote healthy eating among veterinary students.

Weight gain in first-semester university students: Positive sleep and diet practices associated with protective effects

For university students, alterations in sleep and diet quality are common, and the propensity for weight gain is well established. The role of sleep duration during periods of rapid weight gain is understudied. This study explored the relationships between sleep duration, diet patterns, and body composition in first-year university students. Data collection occurred during the beginning of the fall (August) and spring semesters (January). Anthropometric measures included weight, height, and percent body fat (%BF). Survey questions assessed sleep and diet quality. As a group, participants (N = 60) gained weight (1.8 ± 2.1 kg) over the 4.5-month period of study. Hierarchical cluster analysis (HCA) identified three groups based on weight change between baseline and follow-up visits. Group 1 ("maintainers") (N = 21) gained 0.1 ± 1.3 kg, group 2 ("modest gainers") (N = 24) gained 2.0 ± 1.7 kg, and group 3 ("major gainers") (N = 15) gained 3.8 ± 1.8 kg. No differences in weight, body mass index (BMI), %BF, or average sleep duration existed between clusters at baseline. Minimal differences in baseline dietary behaviors between groups were noted other than maintainers used more fat, e.g., butter, to season vegetables, bread, and potatoes compared to modest gainers (p = .010). At follow-up, sleep duration significantly decreased from baseline among major gainers (7.1 ± 0.7 vs. 6.8 ± 0.7 h, p = .017) while sleep duration increased from baseline among maintainers (7.3 ± 0.9 vs. 7.6 ± 1.0 h, p = .048). Sleep duration at follow-up was significantly shorter among major gainers compared to maintainers (p = .016). Total diet scores for maintainers and modest gainers improved between visits (p = .038 and 0.002, respectively) but did not change among major gainers. Combining sleep and diet education may increase the effectiveness of interventions designed to mitigate weight gain in this high-risk population.

Effects of mental health interventions for students in higher education are sustainable over time: a systematic review and meta-analysis of randomized controlled trials

Background

Symptoms of depression, anxiety, and distress are more common in undergraduates compared to age-matched peers. Mental ill health among students is associated with impaired academic achievement, worse occupational preparedness, and lower future occupational performance. Research on mental health promoting and mental ill health preventing interventions has shown promising short-term effects, though the sustainability of intervention benefits deserve closer attention. We aimed to identify, appraise and summarize existing data from randomized control trials (RCTs) reporting on whether the effects of mental health promoting and mental ill health preventing interventions were sustained at least three months post-intervention, and to analyze how the effects vary for different outcomes in relation to follow-up length. Further, we aimed to assess whether the effect sustainability varied by intervention type, study-level determinants and of participant characteristics.

Material and Methods

A systematic search in MEDLINE, PsycInfo, ERIC, and Scopus was performed for RCTs published in 1995-2015 reporting an assessment of mental ill health and positive mental health outcomes for, at least, three months of post-intervention follow-up. Random-effect modeling was utilized for quantitative synthesis of the existing evidence with standardized mean difference (Hedges' g) used to estimate an aggregated effect size. Sustainability of the effects of interventions was analyzed separately for 3-6 months, 7-12 months, and 13-18 months of post-intervention follow-up.

Results

About 26 studies were eligible after reviewing 6,571 citations. The pooled effects were mainly small, but significant for several categories of outcomes. Thus, for the combined mental ill health outcomes, symptom-reduction sustained up to 7-12 months post-intervention (standardized mean difference (Hedges' g) effect size (ES) = -0.28 (95% CI [-0.49, -0.08])). Further, sustainability of symptom-reductions were evident for depression with intervention effect lasting up to 13-18 months (ES = -0.30 (95% CI [-0.51, -0.08])), for anxiety up to 7-12 months (ES = -0.27 (95% CI [-0.54, -0.01])), and for stress up to 3-6 months (ES = -0.30 (95% CI [-0.58, -0.03])). The effects of interventions to enhance positive mental health were sustained up to 3-6 months for the combined positive mental health outcomes (ES = 0.32 (95% CI [0.05, 0.59])). For enhanced active coping, sustainability up to 3-6 months was observed with a medium and significant effect (ES = 0.75 (95% CI [0.19, 1.30])).

Discussion

The evidence suggests long-term effect sustainability for mental ill health preventive interventions, especially for interventions to reduce the symptoms of depression and symptoms of anxiety. Interventions to promote positive mental health offer promising, but shorter-lasting effects. Future research should focus on mental health organizational interventions to examine their potential for students in tertiary education.

The Slow Down Program: A mixed methods pilot study of a mindfulness-based stress management and nutrition education program for mothers

OBJECTIVE

Stress levels have been associated with a broad range of adverse health outcomes, particularly for mothers and subsequently, their children. Mindfulness-based stress management is a tool that has effectively been utilized in several disciplines and has potential applications to eating behaviors. This paper describes the effects of an exploratory mindfulness-based stress management and nutrition education program, the Slow Down Program, on mothers' perceived stress, eating behavior, and self-efficacy.

DESIGN & SETTING

This study used a mixed methods quasi-experimental design. Nineteen mothers with young children (five or younger) participated in the study. The SDP consisted of four consecutive weekly 1.5 h sessions focused on experiential learning and facilitated discussion.

MAIN OUTCOME MEASURES

Quantitative data were collected pre- and post-intervention and included: the Perceived Stress Scale; Mindfulness Self-Efficacy Scale; and the Three-Factor Eating Questionnaire Revised-18. Qualitative data included a focus group post-intervention and an individual interview 4-6 weeks post-intervention.

RESULTS

The SDP showed significant improvements in participants' perceived stress (p = .04), uncontrolled eating (p < 0.01), cognitive restraint (p < 0.01), and mindfulness self-efficacy (p < 0.01). Qualitatively, participants also reported changes in self-efficacy and eating behaviors - specifically improvements in mindful eating, and sensory and satiety awareness.

CONCLUSIONS

The results of this pilot study demonstrate that nutrition programs incorporated with mindfulness strategies may offer positive, short-term impacts on stress reduction and eating behaviors. Additional studies are warranted across a variety of populations with more rigorous study designs to assess long-term effects.

Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review

The incidence of overweight and obesity are increasing with each successive generation of young adults. Associated co-morbidities will emerge at an earlier age unless weight gain is prevented. Evidence has demonstrated young adults (aged 18-35 years) from low socioeconomic and ethnically diverse backgrounds are at greater risk of overweight or obesity, yet it is unclear how to effectively intervene in this population. This systematic review aimed to assess the effectiveness of lifestyle interventions conducted in this population. Thirty studies reporting on lifestyle interventions for prevention of weight gain were identified from eight electronic databases searched. Six interventions included subgroup analyses to determine if ethnicity moderated weight change, and two included subgroup analyses to determine if socioeconomic status had an effect on change in weight. Five of these six studies were effective in preventing weight gain, and subgroup analyses showed no differences in effect by ethnicity. Of these five studies, two included a subgroup analysis that showed socioeconomic status to have no effect on weight outcome. Despite the promising results from these five lifestyle interventions utilizing online and mobile components to effectively reach and prevent weight gain in this priority population, the evidence base of high quality trials is limited.

Promoting Physical Activity Among University Students: A Systematic Review of Controlled Trials

OBJECTIVE

University study is often accompanied by a decline in physical activity (PA) levels but can offer the opportunity to promote a lifelong active lifestyle. This review aims to summarize controlled trials of interventions promoting PA among university students, describing the quality of the evidence, effective strategies, and deficiencies in the interventions employed, to provide directions for future research and for practical implementations.

DATA SOURCE

PubMed, PsychINFO, Cochrane Library, Education Source, and SPORTDiscus. Study Inclusion Criteria: Randomized or nonrandomized controlled trial, describing an intervention to promote PA in university students, where PA was one of the outcomes and results were published in English.

DATA EXTRACTION

Country, study design, participants' inclusion criteria, participation rate and characteristics, randomization, blinding, theoretical framework, intervention characteristics, participant retention rate and withdrawal reasons, measures employed, data analysis, PA results, and findings regarding PA correlates.

DATA SYNTHESIS

Data were synthetized considering study characteristics, strategies used, and outcomes.

RESULTS

Two thousand five hundred eighty-five articles were identified. Twenty-seven studies met the inclusion criteria. Sixteen studies reported an increase in PA levels.

CONCLUSION

Physical Activity promotion interventions should address a range of behavioral determinants. Personalized approaches and PA sessions should be considered in future studies. The high risk of bias of many studies (mainly due to attrition and poor reporting) and missing information about intervention components limit the strength of conclusions about the most effective strategies and the evidence of effectiveness, highlighting the need for further high-quality studies.

The prevalence of patient engagement in published trials: a systematic review

PLAIN ENGLISH SUMMARY

With the growing movement to engage patients in research, questions are being asked about who is engaging patients and how they are being engaged. Internationally, research groups are supporting and funding patient-oriented research studies that engage patients in the identification of research priorities and the design, conduct and uptake of research. As we move forward, we need to know what meaningful patient engagement looks like, how it benefits research and clinical practice, and what are the barriers to patient engagement?We conducted a review of the published literature looking for trials that report engaging patients in the research. We included both randomized controlled trials and non-randomized comparative trials. We looked at these trials for important study characteristics, including how patients were engaged, to better understand the practices used in trials. Importantly, we also discuss the number of trials reporting patient engagement practices relative to all published trials. We found that very few trials report any patient engagement activities even though it is widely supported by many major funding organizations. The findings of our work will advance patient-oriented research by showing how patients can be engaged and by stressing that patient engagement practices need to be better reported.

BACKGROUND

Patient-Oriented Research (POR) is research informed by patients and is centred on what is of importance to them. A fundamental component of POR is that patients are included as an integral part of the research process from conception to dissemination and implementation, and by extension, across the research continuum from basic research to pragmatic trials [J Comp Eff Res 2012, 1:181-94, JAMA 2012, 307:1587-8]. Since POR's inception, questions have been raised as to how best to achieve this goal.We conducted a systematic review of randomized controlled trials and non-randomized comparative trials that report engaging patients in their research. Our main goal was to describe the characteristics of published trials engaging patients in research, and to identify the extent of patient engagement activities reported in these trials.

METHODS

The MEDLINE®, EMBASE®, Cinahl, PsycINFO, Cochrane Methodology Registry, and Pubmed were searched from May 2011 to June 16th, 2016. Title, abstract and full text screening of all reports were conducted independently by two reviewers. Data were extracted from included trials by one reviewer and verified by a second. All trials that report patient engagement for the purposes of research were included.

RESULTS

Of the 9490 citations retrieved, 2777 were reviewed at full text, of which 23 trials were included. Out of the 23 trials, 17 were randomized control trials, and six were non-randomized comparative trials. The majority of these trials (83%, 19/23) originated in the United States and United Kingdom. The trials engaged a range of 2-24 patients/ community representatives per study. Engagement of children and minorities occurred in 13% (3/23) and 26% (6/23) of trials; respectively. Engagement was identified in the development of the research question, the selection of study outcomes, and the dissemination and implementation of results.

CONCLUSIONS

The prevalence of patient engagement in patient-oriented interventional research is very poor with 23 trials reporting activities engaging patients. Research dedicated to determining the best practice for meaningful engagement is still needed, but adequate reporting measures also need to be defined.