Effects of dietary fat feedback on behavioral and psychological variables

Overestimation of physical activity level is associated with lower BMI: a cross-sectional analysis

BACKGROUND

Poor recognition of physical inactivity may be an important barrier to healthy behaviour change, but little is known about this phenomenon. We aimed to characterize a high-risk population according to the discrepancies between objective and self-rated physical activity (PA), defined as awareness.

METHODS

An exploratory cross-sectional analysis of PA awareness using baseline data collected from 365 ProActive participants between 2001 and 2003 in East Anglia, England. Self-rated PA was defined as 'active' or 'inactive' (assessed via questionnaire). Objective PA was defined according to achievement of guideline activity levels (≥30 minutes or <30 minutes spent at least moderate intensity PA, assessed by heart rate monitoring). Four awareness groups were created: 'Realistic Actives', 'Realistic Inactives', 'Overestimators' and 'Underestimators'. Logistic regression was used to assess associations between awareness group and 17 personal, social and biological correlates.

RESULTS

63.3% of participants (N = 231) were inactive according to objective measurement. Of these, 45.9% rated themselves as active ('Overestimators'). In a multiple logistic regression model adjusted for age and smoking, males (OR = 2.11, 95% CI = 1.12, 3.98), those with lower BMI (OR = 0.89, 95% CI = 0.84, 0.95), younger age at completion of full-time education (OR = 0.83, 95% CI = 0.74, 0.93) and higher general health perception (OR = 1.02 CI = 1.00, 1.04) were more likely to overestimate their PA.

CONCLUSIONS

Overestimation of PA is associated with favourable indicators of relative slimness and general health. Feedback about PA levels could help reverse misperceptions.

Accelerometers and Internet for physical activity promotion in youth? Feasibility and effectiveness of a minimal intervention [ISRCTN93896459]

OBJECTIVE

To evaluate the feasibility and effectiveness of a 3-month minimal physical activity (PA) intervention in adolescents.

METHODS

A randomised controlled trial, including five secondary schools (n=87). In the 3-month intervention (Amsterdam, The Netherlands, 2005) adolescents were provided with a PAM accelerometer, coupled to a web-based tailored PA advice (PAM COACH). Measurements (i.e., PA, determinants of PA, aerobic fitness and anthropometrics) took place at baseline and at 3- and 8-month follow-up.

RESULTS

Sixty-five percent of the participants in the intervention group reported to have worn the PAM frequently and 56% of the PAM users uploaded their PAM scores to the PAM COACH at least once. We found significant differences between groups in favour of the intervention group in moderate intensity PA (MPA) for girls after 3 months (411 min/week; 95% CI: 1; 824; P=0.04) and in sedentary time for boys after 8 months (-1801 min/week; 95% CI: -3545; -57; P=0.04).

CONCLUSIONS

Although the process evaluation suggests that a substantial proportion of the participants did not regularly wear the PAM and did not upload information to the PAM COACH website, our findings suggest promising intervention effects on MPA among girls and sedentary time among boys.

Feasibility and effectiveness of online physical activity advice based on a personal activity monitor: randomized controlled trial

Background

Inactive people are often not aware of the fact that they are insufficiently active. Providing insight into their actual physical activity (PA) levels may raise awareness and could, in combination with tailored PA advice, stimulate a physically active lifestyle.

Objective

This study evaluated the feasibility and effectiveness of a 3-month intervention in which Dutch office workers were provided with a personal activity monitor (PAM) coupled to simple and concise Web-based tailored PA advice (PAM COACH).

Method

Participants were randomly assigned to the 3-month PAM intervention (n = 51) or received a single written information brochure with brief general PA recommendations (n = 51). Study outcome measures were changes in PA (recall of minutes per week spent on PA, as measured by the Activity Questionnaire for Adolescents and Adults), determinants of PA, aerobic fitness, and body composition. Follow-up measurements were performed immediately after the 3-month intervention and at 8-months, 5 months after the end of the 3-month intervention period.

Results

A total of 102 workers, 23 to 39 years old, completed the baseline measurement at the worksite. 48 completed the 3-month follow up and 38 the 8-month follow-up in the intervention group, 50 completed the 3-month follow up and 42 the 8-month follow up in the control group. 35 out of 48 (73%) participants in the PAM intervention group reported wearing the PAM regularly, and the PAM COACH was used almost once a week; 24 out of 46 (52%) PAM users set a personal goal, and 33 (72%) entered their favorite activities on the website. Main reasons for not using these items were lack of interest or not being able to find the item on the website. The majority of PAM users (34 out of 46, 74%) read the advice, of whom 14 (39%) found it unappealing. After the 3-month intervention, no significant intervention effect was observed (adjusted difference in min/week) for sedentary behavior (β = 10, 95% CI = −435 to 455), light-intensity PA (β = −129, 95% CI = −337 to 79), moderate-intensity PA (β = −13, 95% CI = −89 to 63), vigorous-intensity PA (β= −6, 95% CI = −75 to 62), and moderate- to vigorous-intensity PA (β = −23, 95% CI = −121 to 76). No significant intervention effect was observed in the PA outcomes at the 8-month follow-up. For the determinants of PA, aerobic fitness, and body composition, no statistically significant intervention effect was observed in the total study population immediately after the 3-month intervention or the 8-month follow-up.

Conclusions

The intervention appeared to be easily applicable to real-life settings. The intervention was ineffective in improving PA behavior or its determinants in healthy office workers. More attention should have been given to the quality and appropriateness of the tailored advice.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 93896459; http://www.controlled-trials.com/ISRCTN93896459/ (Archived by WebCite at http://www.webcitation.org/5iR3mf7ex)

A community-based participatory approach to personalized, computer-generated nutrition feedback reports: the healthy environments partnership

BACKGROUND

Computer tailoring and personalizing recommendations for dietary health-promoting behaviors are in accordance with community-based participatory research (CBPR) principles, which emphasizes research that benefits the participants and community involved.

OBJECTIVE

To describe the CBPR process utilized to computer-generate and disseminate personalized nutrition feedback reports (NFRs) for Detroit Healthy Environments Partnership (HEP) study participants.

METHODS

The CBPR process included discussion and feedback from HEP partners on several draft personalized reports. The nutrition feedback process included defining the feedback objectives; prioritizing the nutrients; customizing the report design; reviewing and revising the NFR template and readability; producing and disseminating the report; and participant follow-up.

LESSONS LEARNED

Application of CBPR principles in designing the NFR resulted in a reader-friendly product with useful recommendations to promote heart health.

CONCLUSIONS

A CBPR process can enhance computer tailoring of personalized NFRs to address racial and socioeconomic disparities in cardiovascular disease (CVD).

A cross-sectional study of awareness of physical activity: associations with personal, behavioral and psychosocial factors

Background

Interventions to promote physical activity frequently target hypothesized mediators of change, but these might be affected by a person's awareness of their own physical activity behavior. The paper aims to characterize a high-risk population by levels of awareness and to study associations between awareness and selected personal, behavioral and psychosocial factors.

Methods

Data were collected on physical activity behavior, physical activity awareness, behavioral and psychosocial factors and anthropometry cross-sectionally at 6-month follow-up in a physical activity promotion trial. Awareness was assessed by comparing dichotomous self-rated physical activity with achieving activity levels according to international guidelines. Four groups were distinguished: 'Realistic Active', 'Realistic Inactive', 'Overestimator', and 'Underestimator'. Data were analyzed with ANCOVA, correcting for previous interventions and current physical activity level.

Results

Of 632 participants (mean age: 56.3 years), 321 were inactive, 61.4% of whom rated themselves as active ('Overestimators'). Compared to 'Realistic Inactives', 'Overestimators' were older, less likely to be smokers or to intend to increase their physical activity level, and had a lower body mass index. Furthermore, 'Overestimators' had similar scores to the 'Realistic Actives' on the psychological factors, but differed significantly from the 'Realistic Inactives'.

Conclusion

People who overestimate their physical activity level appear to be healthier than people who aware of their low activity level. Overestimators also scored more positively on various psychosocial factors and were also less likely to intend to change their physical activity behavior, making awareness a potential barrier in physical activity promotion. Physical activity promotion strategies might include interventions with a focus on increasing awareness in this hard to reach population.

Short-term efficacy of a web-based computer-tailored nutrition intervention: Main Effects and Mediators

BACKGROUND

This study evaluates the short-term efficacy and respondents' evaluations of a Web-based computer-tailored nutrition intervention, aiming to decrease saturated fat intake and increase fruit and vegetable intake. Perceived personal relevance, individualization, and interestingness of the information were tested as mediators of the effects of the tailored intervention.

PURPOSE

The objective was to study the short-term effects of a Web-based computer-tailored nutrition intervention.

METHODS

Respondents (N = 782) were randomly assigned to a tailored intervention group, a generic nutrition information control group, or a no-information control group. Fat, fruit, and vegetable intakes and behavioral determinants were measured at baseline and at 3 weeks postintervention. Posttest group differences were determined by multiple linear regression analyses.

RESULTS

The computer-tailored intervention produced significant effects for the determinants of fat, fruit, and vegetable intake and for vegetable and fruit intake. The tailored information was rated as more personally relevant, individualized, interesting, and new than the generic nutrition information. Perceived personal relevance, individualization, and interestingness were identified as mediators of some of the tailoring effects.

CONCLUSIONS

The findings of this study indicate that Web-based, computer-tailored nutrition information can have a short-term effect on the determinants of fat, fruit, and vegetable intake. The effect of the tailored information may be partly explained by the perceived personal relevance and individualization of the information.

Randomized trial of a low-intensity dietary intervention in rural residents: the Rural Physician Cancer Prevention Project

BACKGROUND

Dietary behavior, specifically a low-fat, high-fiber diet, plays a role in the primary prevention of chronic diseases including cancer.

DESIGN

A community-based randomized trial to assess the impact of a low-intensity, physician-endorsed, self-help dietary intervention that provided tailored dietary feedback, and was designed to promote improved fat and fiber behavior in a rural, low-education/low-literacy, partly minority population. The data were collected from 1999 to 2003.

SETTING/PARTICIPANTS

A total of 754 patients from three physician practices in rural Virginia completed a baseline telephone survey assessing dietary and psychosocial information, and were then randomly assigned to the intervention or control condition. Follow-up telephone evaluation was based on 522 participants at 1 month, 470 at 6 months, and 516 participants at 12 months.

INTERVENTION

A series of tailored feedback, followed by brief telephone counseling and theory-based nutritional education booklets, provided by staggered delivery to the home.

MAIN OUTCOME MEASURES

Dietary fat and fiber behavior, dietary intentions to change, self-efficacy for dietary change, and fat and fiber knowledge.

RESULTS

The intervention group demonstrated significant improvement in dietary fat and fiber behaviors and intentions to change fat and fiber intake (p <0.05) at 1, 6, and 12 months.

CONCLUSIONS

The Rural Physician Cancer Prevention Project provides an effective model for achieving public health-level dietary health behavior changes among a rural, minority, and low-literacy/low-education population.

Short term effect of feedback on fitness and health measurements on self reported appraisal of the stage of change

BACKGROUND

An individual's current status of physical activity and nutrition and readiness to change can be determined using PACE assessment forms. Practitioners have suggested that feedback on the fitness and health components can produce a change in a subject's awareness of their behaviour and thereby lead to a beneficial change in stage of behaviour change.

OBJECTIVE

To evaluate the short term effect of personalised feedback on fitness and health status on self reported appraisal of the stage of change.

METHODS

A total of 299 civil servants were randomised to an intervention or a reference group. After having been tested for fitness and health, the intervention group received immediate feedback on their test results, whereas the reference group did not. PACE assessment forms were completed twice: before testing and after testing (reference group), or after testing and feedback (intervention group). The time interval between was one hour. The influence of feedback was determined using a x(2) test and analysis of variance.

RESULTS

On the basis of the x(2) test, no significant effect of feedback was found on the stage of change of physical activity, nor on the stage of change with regard to nutrition. Analysis of variance results showed no significant effect on the raw PACE score as to physical activity, intake of fruit and vegetables and dietary fat. However, a significant effect was observed on the PACE score of "calorie intake and weight management". Subjects in the intervention group significantly more often regressed on their PACE score on this topic than the reference subjects.

CONCLUSIONS

Feedback at baseline on measurements of an intervention study can influence PACE scores and can be considered as a small but relevant start of the intervention itself.

Interactions between forms of fat consumption and restaurant bread consumption

How does fat consumption influence the consumption of companion foods such as bread? Adult restaurant goers who were randomly given olive oil for their bread used 26% more oil on each piece of bread compared to those who were given block butter, but they ended up eating 23% less bread in total. This finding illustrates one way in which fat intake can interact with the consumption of companion foods.

Feedback strategies to raise awareness of personal dietary intake: results of a randomized controlled trial

BACKGROUND

Feedback is a strategy that can be used to influence awareness of dietary habits. Feedback was applied in an interactive computer-tailored intervention and in printed self-test forms.

METHODS

A randomized controlled trial with a 3 (study groups) x 2 (higher vs. medium or lower educational level) design was conducted. Adult subjects (N = 304) were randomly assigned to a feedback group or the control group. Immediate impact on realism of self-rated intake levels of fat, fruit, and vegetables were tested, as were intentions to change.

RESULTS

Self-rated fat intake compared to others was more realistic among respondents with a medium or lower educational level in the tailored intervention group. Self-rated fruit intake compared to others was more realistic in the tailored intervention group. Self-rated fat intake was more realistic in the tailored intervention than the self-test group. Intention to reduce fat consumption was greater in the tailored intervention group. Intention to eat more vegetables was greater in the tailored than in the self-test group. Subjects rated the tailored intervention as more effective, more personally relevant, more individualized, and providing more new information.

CONCLUSIONS

Only the tailored intervention had an immediate impact on awareness and dietary change intention and was appreciated better than both other interventions.

The effect of accuracy of perceptions of dietary-fat intake on perceived risk and intentions to change

Consumption of excess fat increases risk for many health problems and diseases. In the present study, 188 undergraduate students were studied to understand self-perceptions of dietary-fat intake and the impact of those perceptions. Findings indicated that the majority of participants had inaccurate perceptions about the amount of fat in their diets. Further, compared to people who overestimated dietary-fat intake, people who underestimated fat intake had lower perceived risk of cancer, had lower intentions to change, and demonstrated less knowledge about the dietary-fat content of many foods. Findings suggest that this unrealistic underestimation of fat intake is a cognitive barrier to dietary change and people who underestimate dietary fat intake may require more intensive intervention to change their diets.

The effects of providing personalized dietary feedback. A semi-computerized approach

There not only seems to be a trend for people to underestimate the dietary risks that they face, but it appears that this underestimation may be related to the difficulties they encounter when trying to assess their own dietary intake. A study (n = 118) examining the effects of providing people with information about their own dietary fat intake on their attitudes towards dietary change and their subsequent fat consumption is described. Participants in a group receiving feedback about their fat intake did not decrease their consumption of fat more than did those in a control group. No effects on subsequent fat consumption were observed in a group who had higher than average levels of fat consumption, higher perceived fat consumption than actual fat consumption and who received feedback information about their fat consumption. The results are discussed in relation to their implications for health promotion strategies that focus on the motivational effects of providing people with information about their fat consumption.

The application and impact of computer-generated personalized nutrition education: a review of the literature

Computer-tailored nutrition education may be more effective than general nutrition education because messages are tailored to individual behavior, needs and beliefs of subjects. Therefore, the messages are likely to be of more personal relevance and may have stronger motivational effects. Computer-generated nutrition education has been studied for different dietary behaviors, in different target populations, and in different settings. In recent years, eight studies have been published that assessed the impact of comprehensive computer-generated nutrition interventions that were based on behavior change theory. In this article, the process of providing people with computer-tailored nutrition education is described and the studies on the impact of computer-tailored nutrition education are reviewed. The results point to the conclusion that computer-tailored nutrition education is more likely to be read, remembered, and experienced as personally relevant compared to standard materials. Furthermore, computer-tailored nutrition education also appears to have a greater impact in motivating people to change their diet, their fat intake in particular, although at present no definite conclusions can be drawn.

Effectiveness of a personalized Health Profile for blue-collar workers

This article describes a study on the effectiveness of a Health Profile that was offered to blue-collar workers. The major goal of the Health Profile was to improve workers' awareness of own health behaviors and their intentions to change unhealthy behaviors. The Health Profile consisted of a booklet in A4-format in which tailored information was given on health behaviors. A pretest and posttest design (no control group) was used. The results showed a significant improvement of awareness of own health behaviors. Significant attitudinal changes were also achieved. There were no changes in social support and self-efficacy nor was there a change in the intention to change behaviors. These results suggest that a personalized Health Profile is a promising means to make workers aware of their personal risk behaviors.