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.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
SNEB Member LoginSNEB Members, full access to the journal is a member benefit. Login via the SNEB Website to access all journal content and features.
Subscribe:Subscribe to Journal of Nutrition Education and Behavior
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017; 390: 1345-1422
- Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies.Eur J Nutr. 2019; 58: 173-191
- Interventions to change health behaviours: evidence-based or evidence-inspired?.Psychol Health. 2004; 19: 29-49
- Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions.BMC Public Health. 2011; 11: 119
- The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.Ann Behav Med. 2013; 46: 81-95
- The delivery of public health interventions via the Internet: actualizing their potential.Annu Rev Public Health. 2009; 30: 273-292
- Developing and evaluating digital interventions to promote behavior change in health and health care: recommendations resulting from an international workshop.J Med Internet Res. 2017; 19: e232
- Google Trends.https://trends.google.com/trends/Date accessed: March 15, 2018
- Use of nutritional information in Canada: national trends between 2004 and 2008.J Nutr Educ Behav. 2011; 43: 356-365
- Using the Internet to help with diet, weight, and physical activity: results from the Health Information National Trends Survey (HINTS).J Med Internet Res. 2013; 15: e148
- Who uses the Internet as a source of nutrition and dietary information? An Australian population perspective.J Med Internet Res. 2015; 17: 209
- Use of the internet for health purposes: trends in Norway 2000–2010.Scand J Caring Sci. 2009; 23: 691-696
- The ubiquitous role of smartphones in mobile health.Biom Biostat Int J. 2014; 1
- Internet-delivered health interventions that work: systematic review of meta-analyses and evaluation of website availability.J Med Internet Res. 2017; 19: e90
- A holistic framework to improve the uptake and impact of eHealth technologies.J Med Internet Res. 2011; 13: e111
- The law of attrition revisited.J Med Internet Res. 2006; 8: e20
- The law of attrition.J Med Internet Res. 2005; 7: e11
- Understanding attrition from international Internet health interventions: a step towards global eHealth.Health Promot Int. 2013; 28: 442-452
- Systematic literature review of Internet interventions across health behaviors.Health Psychol Behav Med. 2014; 2: 455-481
- A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors.Ann Behav Med. 2006; 31: 205-223
- A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update.Ann Behav Med. 2012; 44: 259-286
- Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis.Health Technol Assess. 2011; 15: 1-160
- Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence.J Diabetes Complications. 2014; 28: 243-251
National Institute for Health Research. PROSPERO. http://www.crd.york.ac.uk/PROSPERO. Accessed March 13, 2019.
- Rayyan—a web and mobile app for systematic reviews.Syst Rev. 2016; 5: 210
- Understanding controlled trials: why are randomised controlled trials important?.BMJ. 1998; 316: 201
- CONSORT-EHEALTH Group. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions.J Med Internet Res. 2011; 13: e126
- A methodological analysis of randomized clinical trials of computer-assisted therapies for psychiatric disorders: toward improved standards for an emerging field.Am J Psychiatry. 2011; 168: 790-799
- Intervention engagement moderates the dose-response relationships in a dietary intervention.Dose Response. 2016; 141559325816637515
- Effect of an Internet-based, personalized nutrition randomized trial on dietary changes associated with the Mediterranean diet: the Food4Me Study.Am J Clin Nutr. 2016; 104: 288-297
- An interactive web-based intervention on nutritional status, physical activity and health-related quality of life in patient with metabolic syndrome: a randomized-controlled trial (The Red Ruby Study).Nutr Diabetes. 2017; 7: e240
- Favorable outcomes using an eHealth approach to promote physical activity and nutrition among young African American women.J Cardiovasc Nurs. 2018; 33: 62-71
- Men participating in a weight-loss intervention are able to implement key dietary messages, but not those relating to vegetables or alcohol: the Self-Help, Exercise and Diet using Internet Technology (SHED-IT) study.Public Health Nutr. 2011; 14: 168-175
- The SHED-IT randomized controlled trial: evaluation of an Internet-based weight-loss program for men.Obesity (Silver Spring). 2009; 17: 2025-2032
- A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial.Int J Nurs Stud. 2014; 51: 1557-1567
- The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial.J Nutr Educ Behav. 2008; 40: 226-236
- Short- and medium-term efficacy of a Web-based computer-tailored nutrition education intervention for adults including cognitive and environmental feedback: randomized controlled trial.J Med Internet Res. 2015; 17: e23
- Long-term efficacy of a Web-based computer-tailored nutrition education intervention for adults including cognitive and environmental feedback: a randomized controlled trial.BMC Public Health. 2015; 15: 372
- Self-regulation prompts can increase fruit consumption: a one-hour randomised controlled online trial.Psychol Health. 2013; 28: 533-545
- Enabling healthy choices: is ICT the highway to health improvement.Health (London). 2008; 12: 313-331
- Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial.J Med Internet Res. 2014; 16: e231
- Maintenance of weight loss in overweight middle-aged women through the Internet.Obesity (Silver Spring). 2008; 16: 1052-1060
- Motivation, self-efficacy, physical activity and nutrition in college students: randomized controlled trial of an internet-based education program.Prev Med. 2008; 47: 369-377
- Weight loss on the web: a pilot study comparing a structured behavioral intervention to a commercial program.Obesity (Silver Spring). 2007; 15: 155-164
- Comparison of two health-promotion programs for older workers.Am J Public Health. 2011; 101: 883-890
- Dairy intake and related self-regulation improved in college students using online nutrition education.J Acad Nutr Diet. 2012; 112: 1976-1986
- Pounds Off Digitally study: a randomized podcasting weight-loss intervention.Am J Prev Med. 2009; 37: 263-269
- MyPyramid-omega-3 fatty acid nutrition education intervention may improve food groups and omega-3 fatty acid consumption in university middle-aged women.Nutr Res. 2013; 33: 103-108
- Training response inhibition to food is associated with weight loss and reduced energy intake.Appetite. 2015; 95: 17-28
- Diet quality—what is it and does it matter.Public Health Nutr. 2009; 12: 2473-2492
- A self-regulation-based eHealth intervention to promote a healthy lifestyle: investigating user and website characteristics related to attrition.J Med Internet Res. 2017; 19: e241
- Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review.Health Psychol Rev. 2015; 9: 323-344
- The role of behavioral science theory in development and implementation of public health interventions.Annu Rev Public Health. 2010; 31: 399-418
Published online: April 27, 2019
Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.
© 2019 Published by Elsevier Inc. on behalf of Society for Nutrition Education and Behavior.