Tailored smartphone intervention to promote healthy eating among Brazilian adolescents: a randomised controlled trial protocol

Melo, Giselle Rha-isa; Lima, Stefany Corrêa; Chagas, Carolina Martins dos Santos; Nakano, Eduardo Yoshio; Toral, Natacha

doi:10.1136/bmjopen-2020-038896

Cited by 6 publications

(26 citation statements)

References 34 publications

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“…RBR-5b9jk7, trial: http://www.ensaiosclinicos.gov.br/rg/RBR-5b9jk7/ ). The protocol of this intervention has been reported elsewhere ( 11 ). The current analysis examined consumption of food markers, stages of change, self-efficacy for adopting healthy eating practices and nutritional knowledge among individuals aged 16–21 years old.…”

Section: Methodsmentioning

confidence: 99%

“…Senior students were recruited from the last year of seven public high schools of the Federal District, Brazil, that participated in the Health in School Program (HSP, in Portuguese Programa Saúde na Escola) ( 20 ). The inclusion criteria were: possession of a smartphone and use of WhatsApp ( 11 ), which was necessary for the nutritional intervention, but not explored in this article.…”

Section: Methodsmentioning

confidence: 99%

“…New schools were drawn until sample was reached. Data collection took place inside the classrooms, during school hours, in a single day ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

“…Each stage represents different perceptions and degrees of motivation to modify one's diet. They include precontemplation (no intention to improve diet in the near future), contemplation (beginning to consider diet changes, but many barriers are identified), decision (preparation and confidence to improve diet), action (visible and concrete, although recent, diet changes), and maintenance (diet changes sustained for a more significant time, usually more than 6 months) ( 11 ). Another construct of the TTM is self-efficacy, that is the individual's confidence to handle situations without relapsing to former behavior.…”

Section: Introductionmentioning

confidence: 99%

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Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults

Lima

Melo²,

Schincaglia³

et al. 2023

Front. Public Health

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ObjectiveThis study aimed at analyzing the association between stages of change, consumption of food markers, and self-efficacy in the adoption of healthy eating practices, adjusted by nutritional knowledge, among Brazilian adolescents and young adults.MethodsA cross-sectional analysis was conducted with 347 individuals from schools in the Federal District, Brazil. They completed a self-administered questionnaire covering: consumption of food markers, stage of change, self-efficacy in the adoption of healthy eating practices, and nutritional knowledge. Adjusted logistic regression was conducted.ResultsParticipants in pre-contemplation (OR = 0.22), contemplation (OR = 0.19), decision (OR = 0.13) and action (OR = 0.40) stages have less chance to have healthy eating than those in maintenance, including fruits and vegetables [pre-contemplation (OR = 0.23), contemplation (OR = 0.19), and decision (OR = 0.09)]. Adolescents and young adults in pre-contemplation (OR = 0.29) and contemplation (OR = 0.37) had lower chances of having low consumption of sugar-sweetened beverages compared to those in maintenance (p < 0.05). Adolescents and young adults in pre-contemplation (OR = 0.38) and contemplation (OR = 0.36) were less likely to have high self-efficacy scores than those in maintenance (p < 0.05). Higher score of self-efficacy was associated with a lower chance of having a high consumption of sugar-sweetened beverages (OR = 1.02; p = 0.032).ConclusionRegardless of nutritional knowledge, individuals in the earlier stages of change are less likely to have an adequate consumption of healthy foods markers, including fruits and vegetables, and low sugar-sweetened beverages consumption. They are also less likely to have high self-efficacy scores than those in maintenance. Nutritional interventions to focus on enhancing self-efficacy among adolescents and young adults in earlier stages of change to improve dietary habits.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…New schools were drawn until sample was reached. Data collection took place inside the classrooms, during school hours, in a single day ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults

Lima

Melo²,

Schincaglia³

et al. 2023

Front. Public Health

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“…In the control group, 57 students from 2 schools received 42 messages on another topic unrelated to food (prevention of dating violence), with the same duration and frequency. Further details of the nutritional intervention can be found in Melo et al [12].…”

Section: E T H O D Smentioning

confidence: 99%

Memorization of messages, satisfaction, and feasibility of a nutritional intervention using a mobile text messaging app among adolescents

et al. 2022

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Objective This study aimed to evaluate the memorization of messages that promote healthy eating, as well as satisfaction and feasibility of a nutritional intervention using a mobile text messaging app aimed at adolescents from public schools in the Federal District, Brazil. Methods The messages sent addressed aspects of healthy eating based on the Dietary Guidelines for the Brazilian Population. A self-reported questionnaire was applied with 94 students to assess the memorization of the messages received during the nutritional intervention, the level of satisfaction with the intervention, whether the messages were read and shared, the frequency of reading, and what was learned from the intervention. The association of memorization with satisfaction and with the frequency of reading the messages was also investigated. Results About 48% of participants reported remembering at least one message; 77.7% showed high ranges of satisfaction; 54.3% always read the messages; 66.0% did not share messages with other people. Most of the students reported positive learning or good impressions about the intervention. An association was found between memorization and satisfaction with the intervention (p=0.002), as well as between reading and memorization (p=0.005). Conclusion Although the memorization of the healthy eating messages sent in the nutritional intervention was less than expected, a great satisfaction and high frequency of reading the messages were reported by adolescents. Future studies should investigate the permanence of the results of long-term nutrition intervention, the main influencers of memorization, and how to improve it.

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An SMS chatbot digital educational program to increase healthy eating behaviors in adolescence: A multifactorial randomized controlled trial among 7,890 participants in the Danish National Birth Cohort

Bjerregaard,

Zoughbie,

Hansen

et al. 2024

PLoS Med

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Background Few cost-effective strategies to shift dietary habits of populations in a healthier direction have been identified. We examined if participating in a chatbot health education program transmitted by Short Messages Service (“SMS-program”) could improve adolescent dietary behaviors and body weight trajectories. We also explored possible added effects of maternal or peer involvement. Methods and findings We conducted a randomized controlled trial (RCT) among adolescents from the Danish National Birth Cohort (DNBC). Eligible were adolescents who during 2015 to 2016 at age 14 years had completed a questionnaire assessing height, weight, and dietary habits. Two thirds were offered participation in an SMS-program, whereas 1/3 (“non-SMS group”) received no offer. The SMS program aimed to improve 3 key dietary intake behaviors: sugar-sweetened beverages (SSBs), fruit and vegetables (FV), and fish. The offered programs had 3 factorially randomized schemes; the aims of these were to test effect of asking the mother or a friend to also participate in the health promotion program, and to test the effect of a 4-week individually tailored SMS program against the full 12-week SMS program targeting all 3 dietary factors. Height and weight and intakes of SSB, FV, and fish were assessed twice by a smartphone-based abbreviated dietary questionnaire completed at 6 months (m) and 18 m follow-up. Main outcome measures were (1) body mass index (BMI) z-score; and (2) an abbreviated Healthy Eating Index (mini-HEI, 1 m window, as mean of z-scores for SSB, FV, and fish). Among the 7,890 randomized adolescents, 5,260 were assigned to any SMS program; 63% (3,338) joined the offered program. Among the 7,890 randomized, 74% (5,853) and 68% (5,370) responded to follow-ups at 6 m and 18 m, respectively. Effects were estimated by intention-to-treat (ITT) analyses and inverse probability weighted per-protocol (IPW-PP) analyses excluding adolescents who did not join the program. Mean (standard deviation (SD)) mini-HEI at baseline, 6 m and 18 m was −0.01 (0.64), 0.01 (0.59), and −0.01 (0.59), respectively. In ITT-analyses, no effects were observed, at any time point, in those who had received any SMS program compared to the non-SMS group, on BMI z-score (6 m: −0.010 [95% confidence interval (CI) −0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI −0.029, 0.033]; p = 0.901) or mini-HEI (6 m: 0.016 [95% CI −0.011, 0.043]; p = 0.253, 18m: −0.016 [95% CI −0.045, 0.013]; p = 0.286). In IPW-PP analyses, at 6 m, a small decrease in BMI z-score (−0.030 [95% CI −0.057, −0.003]; p = 0.032) was observed, whereas no significant effect was observed in mini-HEI (0.027 [95% CI −0.002, 0.056]; p = 0.072), among those who had received any SMS program compared to the non-SMS group. At 18 m, no associations were observed (BMI z-score: −0.006 [95% CI −0.039, 0.027]; p = 0.724, and mini-HEI: −0.005 [95% CI −0.036, 0.026]; p = 0.755). The main limitations of the study were that DNBC participants, though derived from the general population, tend to have higher socioeconomic status than average, and that outcome measures were self-reported. Conclusions In this study, a chatbot health education program delivered through an SMS program had no effect on dietary habits or weight trajectories in ITT analyses. However, IPW-PP-analyses, based on those 63% who had joined the offered SMS program, suggested modest improvements in weight development at 6 m, which had faded at 18 m. Future research should focus on developing gender-specific messaging programs including “booster” messages to obtain sustained engagement. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT02809196 https://clinicaltrials.gov/study/NCT02809196.

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Tailored smartphone intervention to promote healthy eating among Brazilian adolescents: a randomised controlled trial protocol

Cited by 6 publications

References 34 publications

Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults

Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults

Memorization of messages, satisfaction, and feasibility of a nutritional intervention using a mobile text messaging app among adolescents

An SMS chatbot digital educational program to increase healthy eating behaviors in adolescence: A multifactorial randomized controlled trial among 7,890 participants in the Danish National Birth Cohort

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