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

Abstract

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.

E‐&mHealth interventions targeting nutrition, physical activity, sedentary behavior, and/or obesity among children: A scoping review of systematic reviews and meta‐analyses

“…All reviews assessed intervention efficacy, whereas few assessed reach, engagement, acceptability, or cost‐effectiveness of the interventions (≤5/45 per category, 9/45 overall) 57,73,81,82,86,89–92 . One review focused on the reach, effectiveness, adoption, implementation, and maintenance (RE‐AIM) framework for website interventions 90 .…”

“…All reviews assessed intervention efficacy, but fewer than a quarter assessed a component such as reach, engagement, acceptability, or cost‐effectiveness 57,73,81,82,86,89–92 . Adherence and engagement are assessed multiple ways in e‐&mHealth literature, 101 but adherence metrics within a controlled trial do not necessarily address the external validity of results.…”

Digital Interventions to Promote Healthy Eating in Children: Umbrella Review

“…Similarly, digital nutrition interventions appeared to moderately improve dietary outcomes immediately after the intervention but were not well maintained over time. The long-term success of both traditional [ 40 , 42 , 43 ] and digital [ 28 , 29 , 33 , 35 , 44 ] nutrition interventions have not been well-studied.…”

“…For example, a website may have been counted as an internet-based intervention in 1 review and a computer-based intervention in another; a mobile app may be counted as a mobile-based intervention or a gaming intervention. Other important features of digital nutrition interventions that may be important for effective interventions are personalized feedback, participant interaction with researchers, duration of at least 3 months, and objectives and activities aligned with specific target behaviors [ 44 ]. A meta-analysis of mobile apps aimed at improving the diets in children <18 years found that modeling and social support were significant predictors of intervention ES on dietary outcomes (eg, fruit and vegetable intake and nutrient intake); practicing target desirable behaviors (eg, eating vegetables) was a significant predictor of intervention ES for children but not adolescents [ 45 ].…”

A Cluster Randomized Controlled Trial Evaluating the Impact of Tailored Feedback on the Purchase of Healthier Foods from Primary School Online Canteens

“…For example, meta-analyses on the long term effect of tailored compared to generic nutrition education found that tailored approaches were associated with an increase in daily fruit and vegetable consumption and a decrease in energy consumed from total fat [ 15 ]. Tailored messages and feedback have also been identified as characteristics that contribute to effective interventions in reviews of digital or online interventions targeting children and adolescents [ 16 ] and adults [ 17 ]. A recent meta-analysis of 19 e-health interventions on fruit and vegetable effectiveness demonstrated a greater effect among tailored interventions [ 18 ].…”