Using technology to promote self-efficacy for healthy eating in adolescents

Design and evaluation of a computer game to promote a healthy diet for young adults

This article reports the development and evaluation of a computer game (RightWay Café) as a special medium to promote a healthy diet for young adults. Structural features of computer games, such as interactive tailoring, role playing, the element of fun, and narrative, were operationalized in the RightWay Café game to afford behavior rehearsal in a safe and entertaining way. Theories such as the health belief model, social cognitive theory, and theory of reasoned action guided the content design of the game to influence mediators of behavior change, including self-efficacy, perceived benefits, perceived barriers, and behavior change intention. A randomized controlled evaluation study with pretest, posttest, and follow-up design demonstrated that this game was effective in teaching nutrition and weight management knowledge and increasing people's self-efficacy and perceived benefits of healthy eating, as well as their intention to be on a healthy diet. Limited long-term effects were also found: participants in the game-playing group had greater self-efficacy than participants in the control group after 1 month. This study validates the computer game-based approach to health promotion for young adults. Limitations and implications are also discussed.

A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults

BACKGROUND

Population ageing affects most undeveloped, developing and developed countries. Less than a quarter of older people undertake a level of physical activity worldwide that is sufficient to lead to health benefits. Understanding older people's confidence regarding engaging in exercise helps to structure physical activity interventions that motivate them to initiate and adhere to regular exercise. Estimates of the reliability and validity of the English version of the self-efficacy for exercise (SEE) scale has been widely tested and shown to be valid for use in various settings and among older people. The reliability and validity of a Chinese version of the SEE for older adults has not been tested.

AIM

To undertake a preliminary assessment of the reliability and validity of the SEE scale when applied to the older Chinese adults.

METHODS

The Chinese version of the self-efficacy for exercise (SEE-C) scale was tested on a sample of 192 older people from Taiwan with a mean age of 71.2 years recruited between October and December 2003.

RESULTS

There was acceptable internal consistency of the SEE-C scale. The fit of the measurement model to the data for the SEE-C scale was acceptable. There was evidence of validity of the measure based on hypothesis testing: health status predicted exercise self-efficacy, and exercise self-efficacy predicted physical activity. Those who exercised regularly (n=102) had a higher mean SEE-C score (5.3) than those who did not (2.9, n=90).

CONCLUSION

This preliminary validation study provided evidence for the reliability and validity of the Chinese version of the SEE scale. Future testing of the SEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas and with different characteristics. A test of the scale among younger adults for a wider use of the instrument is also warranted.

Desenvolvimento e aplicação de um questionário semiquantitativo de freqüência alimentar on-line para estimar a ingestão de cálcio e ferro

OBJETIVO: Desenvolver um questionário semiquantitativo de freqüência alimentar on-line para a avaliação de ingestão de cálcio (Ca) e de ferro (Fe). METODOLOGIA: O site de acesso à pesquisa foi o jornal eletrônico Folha Online. Trinta internautas, de ambos os sexos, residentes no estado de São Paulo, com idades de 21 a 45 anos foram selecionados. Informações obtidas de Registros Alimentares de 4 dias em dois meses consecutivos foram comparadas com as do questionário semiquantitativo de freqüência alimentar preenchido pelos participantes no terceiro mês. Para a análise estatística foram calculados coeficientes de correlação de Pearson. Os dados dietéticos foram ajustados pela energia e pela variância. RESULTADOS: O coeficiente de correlação entre os resultados obtidos por meio dos dois métodos, após o ajuste pela energia e da correção pela variância, foi de 0,52 para Ca e r = -0,02 para Fe. CONCLUSÃO: Os resultados indicam que o QSFA on-line pode ser utilizado para avaliar médias de ingestão de Ca nesse grupo. No entanto, as condições (n, nível de ingestão) não foram adequadas para a avaliação da média de ingestão de Fe.

Association of multiple behavioral risk factors with adolescents' willingness to engage in eHealth promotion

OBJECTIVE

This study examines adolescents' willingness to use the internet and other forms of technology for health promotion purposes (i.e., "eHealth promotion" willingness) and determines if a relationship exists between adolescents' behavioral risks and their eHealth promotion willingness.

METHODS

A total of 332 adolescents provided data at a routine medical check-up, including assessments of technology access, eHealth promotion willingness, and multiple behavioral risk factors for child- and adult-onset disease (body mass index, physical activity, smoking, sun protection, depression).

RESULTS

The level of access to technology among the sample was high, with moderate willingness to engage in eHealth promotion. After adjusting for adolescents' access to technology, the presence of multiple behavioral risk factors was positively associated with willingness to use technology for health promotion purposes (beta =.12, p =.03).

CONCLUSIONS

Adolescents with both single and multiple behavioral risk factors are in need of health promotion to prevent the onset of disease later in life. eHealth appears to be an acceptable and promising intervention approach with this population.

State of the Art Reviews: Using the Internet to Promote Physical Activity and Healthy Eating in Youth

The prevalence of overweight children and adolescents is increasing at alarming rates. Since 1980, the prevalence of overweight among children aged 6 to 11 years has more than doubled and more than tripled among adolescents aged 12 to 19. Innovative, effective weight loss strategies that effectively promote healthy eating and physical activity are needed to address this obesity epidemic. The Internet may prove to be an effective means of reaching youth to reduce overweight and, ideally, prevent weight gain. This article reviews the available literature of Internet-based interventions promoting healthy eating, physical activity, and/ or weight loss in school, home, camp, and medical settings. Findings show that few examples of well-designed trials exist in the youth literature. However, several studies show promise for the use of the Internet. It is recommended that future trials use adequate sample sizes, randomized designs, objective measures, boys and girls, health disparity youth, longer intervention periods (at least 16 weeks), long-term follow-up, theory-based skill building (eg, tracking of behavior, goal setting, feedback, increasing social support), the involvement of parents or caretakers, and improved means for sustaining interest and use in the site over time.

A review of eHealth interventions for physical activity and dietary behavior change

OBJECTIVE

To review eHealth intervention studies for adults and children that targeted behavior change for physical activity, healthy eating, or both behaviors.

DATA SOURCES

Systematic literature searches were performed using five databases: MEDLINE, PsychInfo, CINAHL, ERIC, and the Cochrane Library to retrieve articles.

STUDY INCLUSION AND EXCLUSION CRITERIA

Articles published in scientific journals were included if they evaluated an intervention for physical activity and/or dietary behaviors, or focused on weight loss, used randomized or quasi-experimental designs, measured outcomes at baseline and a follow-up period, and included an intervention where participants interacted with some type of electronic technology either as the main intervention or an adjunct component. All studies were published between 2000 and 2005.

RESULTS

Eighty-six publications were initially identified, of which 49 met the inclusion criteria (13 physical activity publications, 16 dietary behaviors publications, and 20 weight loss or both physical activity and diet publications), and represented 47 different studies. Studies were described on multiple dimensions, including sample characteristics, design, intervention, measures, and results. eHealth interventions were superior to comparison groups for 21 of 41 (51%) studies (3 physical activity, 7 diet, 11 weight loss/physical activity and diet). Twenty-four studies had indeterminate results, and in four studies the comparison conditions outperformed eHealth interventions.

CONCLUSIONS

Published studies of eHealth interventions for physical activity and dietary behavior change are in their infancy. Results indicated mixed findings related to the effectiveness of eHealth interventions. Interventions that feature interactive technologies need to be refined and more rigorously evaluated to fully determine their potential as tools to facilitate health behavior change.

Online health promotion, early identification of difficulties, and help seeking in young people

OBJECTIVE

To examine the use and impact of a dedicated health information Web site for adolescents.

METHOD

Five hundred fifty-eight (27.2%) of all students in grades 7 through 12 from 4 schools logged onto the Web site; 1775 (86.4%) of all students in these grades completed a year-end health survey, with 455 (81.5%) of the students who used the Web site completing the survey. Dependent variables were help seeking and satisfaction ratings plus visits to specific Web site sections. Predictor variables were demographic characteristics, mental health, and psychosocial difficulties assessed at years' end.

RESULTS

Students logged on >11,000 times during the year. Female students, students wanting professional help, those scoring higher on depressive vulnerability measures, and students reporting more severe mood problems were related to logging on frequently over longer periods of time, as well as viewing information sheets, posting and viewing questions and answers, and completing the symptom screen. Students accessing the Web site from 1 to 7 A.M. reported higher levels of distress than did students who accessed the Web site at other times of the day. Visits to the Web site were positively associated with visits to school health centers and guidance counselors and referrals to a health professional.

CONCLUSIONS

Results are consistent with a health-needs model of utilization of this Internet-based health resource. A school-based health information Web site holds significant promise for health promotion and early self-identification for emotional problems.

Pilot using World Wide Web to prevent diabetes in adolescents

This pilot study tested the effects of an interactive nutrition education Web site on fruit, vegetable, and fat consumption in minority adolescents genetically at risk for Type 2 diabetes. A one-group nonexperimental pretest, posttest focus group design was used. Twenty-one sixth-grade to eighth-grade junior high adolescents who were minorities volunteered to participate. Participants received 5 hours of Web-based nutrition education over 3 weeks. A significant difference in fat consumption was supported from the computerized dietary assessment. No difference was found in fruit or vegetable consumption. Comparative data indicated a rise in body mass index (BMI) percentile from 88.03 (1999) to 88.40 (2002; boys) and 88.25 (1999) to 91.2 (2002; girls). Focus group responses supported the satisfaction of adolescents in the study with the use of the Web-based intervention for nutrition education. Healthy eating interventions using Web-based nutrition education should be further investigated with adolescents.

Improving the dietary patterns of adolescents using a computer-based approach

The Centers for Disease Control and Prevention (CDC) recently reported that 16-33% of children and adolescents in the United States are overweight or obese, making this the number one nutritional disease of this group. The prevalence appears to be increasing annually, as are the associated consequences. Moreover, the CDC estimates that less than 50% of adolescents are physically active on a regular basis. In order to improve the health of these individuals, an intervention must be focused to modify these behaviors. Facilitating the understanding of proper nutrition and need for physical activity among adolescents will likely prevent health problems such as overweight and obesity and the development of chronic diseases later in life. Despite these concerns, adolescents remain one of the most underserved populations in terms of preventive services. In the past, health education interventions have shown increases in knowledge; however, the ultimate goal of these programs is to positively impact behavior. To accomplish this, we must focus on the learning styles of "today's" adolescents. Computer-based interventions allow for individualized strategies to promote healthy lifestyles. A computer-based intervention program has the potential to elicit a greater behavior change in comparison to a traditional didactic intervention program.

A 10-year retrospective of research in new technologies for health communication

The use of new technologies is growing in virtually all areas of health communication, including consumer, patient, and provider education; decision and social support; health promotion; knowledge transfer; and the delivery of services. Many applications have the potential to make major contributions in meeting the needs of an unhealthy and aging population. Key questions confronting health communication research reflect long-standing concerns about effects of new technology on health knowledge, health behavior, health delivery, and health outcomes. A review of the literature provides useful insights about how technology has been used to communicate health messages and their associated outcomes. Focus is placed on effective health communication, lessons learned, and implications for the future. During the next 10 years, the application of new technologies in health communication will be enriched by a tradition that has evolved to reflect a more dynamic connection between health users and providers. Future applications have the potential to provide cost-effective communications tailored to large numbers of individuals and achieve positive health outcomes. Consequently, we should strive to answer research questions about tailoring communication content, the channel used to deliver the message, and evaluation models that are best suited for examining outcomes of multicomponent tailored, technology-based communication.

The internet and nutrition education: challenges and opportunities

OBJECTIVE

To review the possibilities of using the Internet and especially the World Wide Web (WWW) in nutrition education.

RESULTS

A healthy existence is partly dependent on dietary behaviours. One way to promote health-promoting dietary habits is nutrition education. In the last decades several potentially important new channels for health communication and nutrition education have emerged, with the Internet and its WWW as the most striking example. The introduction and growth of the WWW has enabled swift and inexpensive distribution of nutrition education expertise and materials. Furthermore, the WWW has also been used for tailoring nutrition education to the personal characteristics of the user. Only few studies have investigated the effects of generic web-based nutrition education, while web-based computer-tailored nutrition education has been studied in randomised controlled trials, with promising but mixed results. Two important challenges for web-based nutrition education interventions are to realise sufficient exposure and to ensure sufficient source reliability and credibility.

CONCLUSIONS

Next to the great opportunities, there are many challenges for web-based nutrition education. Some evidence for effects of web-based computer-tailored nutrition education has been reported, but more research is needed to obtain evidence for the effectiveness in real-life situations.