Abstract
Introduction
Poor diet is a leading cause of death and disease globally. This epidemic requires
effective and accessible interventions to stop the increasing number of diet-related
deaths and the health and economic impacts of diet-related disease. Online interventions
provide flexibility and accessibility. With the ubiquitous use of smartphones, they
can be intertwined with daily activities such as shopping and eating. The aim of this
review is to determine what features and behavior change techniques employed in online
dietary interventions for adult populations promoting dietary behavior change.
Methods
The researchers conducted a systematic search of Cumulative Index of Nursing and Allied
Health, Cochrane Library, Global Health, MEDLINE, PsychINFO, and psychological and
behavioral sciences electronic bibliography databases, and specialist electronic health
(e-health) journals from database inception to January, 2018. Studies were included
if they were randomized controlled trials of online dietary interventions with active
comparator conditions in adult populations, and with reported dietary change measures.
A quality score was applied to each study calculated by a developed scoring system.
The review analyzed intervention dietary change measures, attrition (nonuse and dropout),
engagement (metrics and intensity of use), adherence (defined as compliance to the
treatment protocol), behavior change techniques employed to achieve dietary change,
and techniques employed in successful (those who achieved significant results in the
targeted dietary behavior) vs unsuccessful interventions as reported by the studies.
Results
A total of 21 studies composed of a total of 7,455 adults and reporting on 19 different
e-health interventions were included from 1,237 records. These studies targeted dietary
change as measured by reduced energy intake (5) or changes in specific dietary components
(15) and overall diet quality (4). Dietary change was a behavior target in general
healthy populations (12) and for managing diseases such as obesity and cardiovascular
disease (7), or for improving quality of life for those with chronic conditions (1).
Improvements in dietary behavior were seen in 14 of the 19 interventions reported.
Discussion
The results suggest that online interventions can be successful in achieving dietary
behavior change across a range of defined populations. However, disparate reporting
of engagement and limited reporting of nonuse attrition rates limited the analysis
of which behavior change techniques were most effective in achieving this change.
Implications for Research and Practice
The results of this review support the potential of online and smartphone dietary
interventions as a method to achieve change in diet in defined populations. However,
further work needs to be done in examining how users engage with interventions, and
thus which behavior change techniques are most effective.
Key Words
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Article info
Publication history
Published online: April 27, 2019
Footnotes
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of Society for Nutrition Education and Behavior.
