Economic analysis of bilingual interactive multimedia nutrition education

Medical utilization of kiosks in the delivery of patient education: a systematic review

BACKGROUND

The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education.

METHODS

The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014.

RESULTS

Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis.

CONCLUSION

The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education.

A community based prevention of weight gain intervention (Mothers In Motion) among young low-income overweight and obese mothers: design and rationale

BACKGROUND

Over 45% of American women 20-39 years old are at risk for type 2 diabetes, cardiovascular disease, and other health conditions because they are overweight or obese. The prevalence of overweight and obesity is disproportionately high among low-income women. This paper describes the study design and rationale of a community based intervention (Mothers In Motion, MIM) aimed to prevent weight gain among low-income overweight and obese mothers 18-39 years old by promoting stress management, healthy eating, and physical activity.

METHODS/DESIGN

Peer recruiters approach participants from 5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. The MIM delivers theory-based, culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences (PSGTs). The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM. The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills. Participants are randomly assigned to an intervention (n=350) or comparison group (n=175). The intervention group receives a 16-week intervention on a weekly or bi-weekly basis. Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone. The comparison group receives printed educational materials. The primary outcome is body weight. Secondary outcomes include dietary fat, fruit, and vegetable intake; physical activity; stress, and affect. Mediators are self-efficacy, emotional coping response, social support, and autonomous motivation. Telephone interviews and in-person data collection at WIC offices occur at 3 time points: baseline, immediately, and 3 months after the 16-week intervention.

DISCUSSION

If MIM shows effectiveness, it could have a favorable impact on public health and community programs. The DVDs and PSGTs will be disseminated in WIC, Extension, clinical practice that promote healthy lifestyles for similar target audiences to make a broad contribution to the prevention of weight gain in low-income mothers. Also, our methodology can be adapted by researchers and community stakeholders to help other low-income populations prevent weight gain.

TRIAL REGISTRATION

Clinical Trials Number: NCT01839708.

A meta-analysis of computer-tailored interventions for health behavior change

OBJECTIVE

Computer-tailored interventions have become increasingly common for facilitating improvement in behaviors related to chronic disease and health promotion. A sufficient number of outcome studies from these interventions are now available to facilitate the quantitative analysis of effect sizes, permitting moderator analyses that were not possible with previous systematic reviews.

METHOD

The present study employs meta-analytic techniques to assess the mean effect for 88 computer-tailored interventions published between 1988 and 2009 focusing on four health behaviors: smoking cessation, physical activity, eating a healthy diet, and receiving regular mammography screening. Effect sizes were calculated using Hedges g. Study, tailoring, and demographic moderators were examined by analyzing between-group variance and meta-regression.

RESULTS

Clinically and statistically significant overall effect sizes were found across each of the four behaviors. While effect sizes decreased after intervention completion, dynamically tailored interventions were found to have increased efficacy over time as compared with tailored interventions based on one assessment only. Study effects did not differ across communication channels nor decline when up to three behaviors were identified for intervention simultaneously.

CONCLUSION

This study demonstrates that computer-tailored interventions have the potential to improve health behaviors and suggests strategies that may lead to greater effectiveness of these techniques.

Food safety education using an interactive multimedia kiosk in a WIC setting: correlates of client satisfaction and practical issues

OBJECTIVE

To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic.

METHODS

Female clients or caregivers (n=176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk. Satisfaction with program, participant demographics, and change in food-handling behavior were assessed by univariate analyses.

RESULTS

Over 90% of the participants enjoyed the kiosk, and most (87.5%) reported using computers a lot. Compared with participants with education beyond high school, participants with less education were more likely to report enjoying the kiosk (98.2% vs 88.1%, P = .007), preferred learning with the kiosk (91.7% vs 79.1%, P = .02), and would like to learn about other topics using IMM (95.4% vs 86.6%, P = .04).

CONCLUSIONS AND IMPLICATIONS

Food safety education delivered by IMM was well accepted by inner-city WIC clinic clients, including those with less education.

The role of health kiosks in 2009: literature and informant review

Kiosks can provide patients with access to health systems in public locations, but with increasing home Internet access their usefulness is questioned. A literature and informant review identified kiosks used for taking medical histories, health promotion, self assessment, consumer feedback, patient registration, patient access to records, and remote consultations. Sited correctly with good interfaces, kiosks can be used by all demographics but many ‘projects’ have failed to become routine practice. A role remains for: (a) integrated kiosks as part of patient ‘flow’, (b) opportunistic kiosks to catch people’s attention. Both require clear ‘ownership’ to succeed.

Randomized controlled trial to determine the effectiveness of an interactive multimedia food safety education program for clients of the special supplemental nutrition program for women, infants, and children

BACKGROUND

Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections.

OBJECTIVE

To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients.

DESIGN

A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention.

SUBJECTS/SETTING

Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic.

INTERVENTION

Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk.

MAIN OUTCOME MEASURES

Change from pre- to postintervention food safety scores.

STATISTICAL ANALYSES PERFORMED

A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance.

RESULTS

Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score.

CONCLUSIONS

The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review

OBJECTIVE

This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs.

DESIGN

A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies.

OUTCOME MEASURES

Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors.

RESULTS

Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos.

CONCLUSIONS AND IMPLICATIONS

There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.

Parent use of touchscreen computer kiosks for child health promotion in community settings

OBJECTIVES

The goals were to evaluate the use of touchscreen computer kiosks, containing only child health-promoting information, in urban, low-income, community settings and to characterize the users of these kiosks.

METHODS

Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonald's restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data.

RESULTS

In total, there were 1846 kiosk sessions. Almost one half occurred at McDonald's. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to > or = 1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their child's doctor about what they had learned.

CONCLUSIONS

User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.

Comparative Validation of a Bilingual Interactive Multimedia Dietary Assessment Tool

OBJECTIVE

To perform comparative validity testing for a bilingual interactive multimedia (IMM) dietary assessment tool that mimics a dietary recall against an interview-administered dietary recall.

DESIGN

This was a two-period crossover design study. First, participants were randomly assigned to complete an IMM recall or interview-administered 24-hour recall. The IMM recall generated a nutrient profile that included 20 dietary constituents. The interview-administered recall was analyzed using the Food Intake Analysis System (FIAS) and the Expanded Food and Nutrition Education Program (EFNEP) Evaluating/Reporting System. The effect of substituting standardized portion sizes for reported portion sizes was examined.

SUBJECTS/SETTING

Of 80 adult participants, 71 (91%) were female, 45 (56%) had 12th grade or less education, 65 (81%) had an annual income of dollar 15,000 or less, and 21 (26%) completed the IMM recall in Spanish.

STATISTICAL ANALYSES PERFORMED

Analysis of variance and unadjusted and energy-adjusted correlations were used.

RESULTS

No significant group differences were found for order of administration or demographic characteristics. There was only one significant (P=.025) method effect, whereby vitamin C intake was higher in the IMM recall than the FIAS. The unadjusted correlations between the IMM recalls and interview-administered recalls analyzed using both FIAS and EFNEP Evaluating/Reporting System were generally approximately 0.6. Energy-adjusted correlations were consistently lower. Substituting standardized portion sizes resulted in significant differences for six nutrients and caused all correlations to decrease.

CONCLUSIONS

The IMM dietary recall is a valid method for assessing dietary intake within the tested group. The results of comparative validity testing and positive reactions received from participants and nutrition educators indicate that diet assessment using IMM has tremendous potential.

Doing well by doing good? A supermarket shuttle feasibility study

OBJECTIVE

Creating a more healthful food environment requires a new line of research that examines the impact of healthful changes on business's bottom line. This study investigates whether supermarket-sponsored shuttles can be self-supporting or make a profit in low-income urban areas.

DESIGN

2000 Census data were used to identify zip codes in California with low income, low vehicle ownership, and high population density to identify potential markets for shuttle programs. The breakeven point was calculated for a hypothetical shuttle program operating in these zip codes.

MAIN OUTCOME MEASURES

Breakeven point in the number of months of shuttle operation.

ANALYSIS

Breakeven analysis.

RESULTS

Sixty-seven zip codes met the criteria for inclusion in the study. A supermarket shuttle program would break even in most zip codes if 10% of households without a car used the shuttle. If 15% used the shuttle, shuttle programs in all zip codes would make a profit.

CONCLUSIONS

A shuttle program could be self-supporting in all 67 zip codes.

IMPLICATIONS

Those interested in changing the food environment to support a healthful diet could use this information to share with supermarket executives and other key decision makers.