Research Article| Volume 46, ISSUE 6, P506-546, November 2014

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Influence of Behavioral Theory on Fruit and Vegetable Intervention Effectiveness Among Children: A Meta-Analysis

  • Cassandra S. Diep
    Address for correspondence: Cassandra S. Diep, PhD, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, 1100 Bates St, Houston, TX 77030; Phone: (713) 798-0387; Fax: (713) 798-7098.
    US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX

    Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
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  • Tzu-An Chen
    US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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  • Vanessa F. Davies
    US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX

    Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
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  • Janice C. Baranowski
    US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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  • Tom Baranowski
    US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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      To test the hypotheses that interventions clearly based on theory, multiple theories, or a formal intervention planning process will be more effective in changing fruit and vegetable consumption among children than interventions with no behavioral theoretical foundation.


      Systematic review and meta-analysis.


      Identification of articles in PubMed, PsycInfo, Medline, Cochrane Collaborative database, and existing literature reviews and meta-analyses.


      Children aged 2–18 years.


      Change in fruit and/or vegetable consumption in dietary change interventions.


      Meta-analysis, meta-regression analysis, and summary reporting for articles.

      Conclusions and Implications

      Predicating an intervention on behavioral theory had a small to moderate enhancement (P < .001) of outcome effectiveness. Differences in mean Hedges' g effect sizes between theory and non-theory interventions were 0.232 for fruit, 0.043 for vegetables, and 0.333 for fruit and vegetables combined. There was mixed support, however, for enhanced dietary change with multiple theories or a formal planning process. After controlling for study quality, theory use was related only to vegetable consumption (β = 0.373; P < .001). More research is needed on theory's influences on dietary behaviors to guide future interventions among children. More research is also needed to identify what may be effective practical- or experience-based procedures that complement theory, to incorporate into interventions.

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