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Ronteltap A, Bukman AJ, Nagelhout GE, Hermans RCJ, Hosper K, Haveman-Nies A, Lupker R, Bolman CAW. Digital health interventions to improve eating behaviour of people with a lower socioeconomic position: a scoping review of behaviour change techniques. BMC Nutr 2022; 8:145. [PMID: 36482430 PMCID: PMC9733085 DOI: 10.1186/s40795-022-00635-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
Specific approaches are needed to reach and support people with a lower socioeconomic position (SEP) to achieve healthier eating behaviours. There is a growing body of evidence suggesting that digital health tools exhibit potential to address these needs because of its specific features that enable application of various behaviour change techniques (BCTs). The aim of this scoping review is to identify the BCTs that are used in diet-related digital interventions targeted at people with a low SEP, and which of these BCTs coincide with improved eating behaviour. The systematic search was performed in 3 databases, using terms related to e/m-health, diet quality and socioeconomic position. A total of 17 full text papers were included. The average number of BCTs per intervention was 6.9 (ranged 3-15). BCTs from the cluster 'Goals and planning' were applied most often (25x), followed by the clusters 'Shaping knowledge' (18x) and 'Natural consequences' (18x). Other frequently applied BCT clusters were 'Feedback and monitoring' (15x) and 'Comparison of behaviour' (13x). Whereas some BCTs were frequently applied, such as goal setting, others were rarely used, such as social support. Most studies (n = 13) observed a positive effect of the intervention on eating behaviour (e.g. having breakfast) in the low SEP group, but this was not clearly associated with the number or type of applied BCTs. In conclusion, more intervention studies focused on people with a low SEP are needed to draw firm conclusions as to which BCTs are effective in improving their diet quality. Also, further research should investigate combinations of BCTs, the intervention design and context, and the use of multicomponent approaches. We encourage intervention developers and researchers to describe interventions more thoroughly, following the systematics of a behaviour change taxonomy, and to select BCTs knowingly.
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Affiliation(s)
- Amber Ronteltap
- grid.438049.20000 0001 0824 9343Knowledge Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, P.O. box 12011, 3501 AA Utrecht, The Netherlands
| | - Andrea J. Bukman
- grid.438049.20000 0001 0824 9343Knowledge Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, P.O. box 12011, 3501 AA Utrecht, The Netherlands
| | - Gera E. Nagelhout
- IVO Research Institute, The Hague, The Netherlands ,grid.5012.60000 0001 0481 6099Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Roel C. J. Hermans
- grid.5012.60000 0001 0481 6099Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands ,grid.491176.c0000 0004 0395 4926Netherlands Nutrition Centre, The Hague, The Netherlands
| | | | - Annemien Haveman-Nies
- grid.4818.50000 0001 0791 5666Consumption and Healthy Lifestyles Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Remko Lupker
- grid.36120.360000 0004 0501 5439Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Catherine A. W. Bolman
- grid.36120.360000 0004 0501 5439Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
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Investigating Web-Based Nutrition Education Interventions for Promoting Sustainable and Healthy Diets in Young Adults: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031691. [PMID: 35162714 PMCID: PMC8835600 DOI: 10.3390/ijerph19031691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/04/2022]
Abstract
Background: Our current rapidly growing food systems are imposing a heavy burden on both environmental sustainability and human health. Sustainable and healthy diets aim to promote optimal health and have a minimal environmental impact. This study aimed to critically review and synthesise the evidence on the effectiveness of web-based nutrition education interventions aiming to promote sustainable and healthy diets among young adults. Methods: A systematic search of four databases (Medline, PsycINFO, Scopus, and Embase) was conducted in March 2021. Studies were included if they used an online platform to deliver the intervention to young adults and measured at least one aspect of sustainable and healthy diets, such as plant-based food intake, food waste, and local and seasonal produce. Of the 2991 studies, a total of 221 full-text articles were assessed for eligibility of which 22 were included in the final review. Results: A majority of the studies (82%) targeted fruit and vegetable consumption, and close to a quarter of studies (23%) targeted other aspects of a sustainable and healthy diet, such as red meat intake. Only one study included multiple aspects of a sustainable and healthy diet. Program delivery outcomes reported overall positive feedback and engagement. Conclusion: This review suggests that web-based interventions may be effective in promoting some sustainable diet-related outcomes in young adults. However, there is a need for developing and evaluating future programs to promote sustainable diets more comprehensively in order to help young adults make healthy and sustainable food choices.
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Perry SP, Wages JE, Skinner-Dorkenoo AL, Burke SE, Hardeman RR, Phelan SM. Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US. THE JOURNAL OF SOCIAL ISSUES 2021; 77:769-800. [PMID: 34924602 PMCID: PMC8680271 DOI: 10.1111/josi.12448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Self-affirmation interventions have been shown to mitigate the negative psychological effects of stereotype threat on Black students in secondary and undergraduate education. However, there is currently limited research testing whether Black students in medical schools may also experience the negative influences of stereotype threat. Until now, it has been unclear whether Black (vs. White) students experience a lower sense of belonging in medical school and whether they can benefit from self-affirmation interventions during medical training. With a longitudinal field experiment, we tested (a) whether Black (vs. White) medical students in the US experience decrements in psychological well-being (i.e., fatigue, depression, anxiety), sense of belonging, perceived residency competitiveness, and residency goal stability; and (b) the extent to which a self-affirmation intervention would ameliorate any observed disparities in these outcomes for Black students. With a sample of 234 Black and 182 White medical students across 50 schools in the US, we found that Black students tended to report more fatigue and less belonging than White students; however, the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety, or belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower perceived competitiveness for residency. White students' perceived competitiveness for residency was unaffected by the intervention. Exploratory analyses revealed that Black (vs. White) students were less likely to indicate stable residency goals over time, which may be an indication of threat; however, this racial gap was eliminated with the intervention. We discuss the plausible reasons for these findings and provide recommendations for future work in this area.
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Affiliation(s)
| | | | | | | | - Rachel R Hardeman
- Division of Health Policy & Management, University of Minnesota School of Public Health
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Dijkstra A, Elbert SP. Detecting and Preventing Defensive Reactions Toward Persuasive Information on Fruit and Vegetable Consumption Using Induced Eye Movements. Front Psychol 2021; 11:578287. [PMID: 33505330 PMCID: PMC7829457 DOI: 10.3389/fpsyg.2020.578287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Persuasive messages regarding fruit and vegetable consumption often meet defensive reactions from recipients, which may lower message effectiveness. Individual differences in emotion regulation and gender are expected to predict these reactions. In the working memory account of persuasion, inducing voluntary eye movements during the processing of the auditory persuasive information might prevent defensiveness and thereby increase message effectiveness. Methods: Participants in two independently recruited samples from the general population (n = 118 and n = 99) listened to a negatively framed auditory persuasive message advocating fruit and vegetable consumption. Half of them were asked to keep following a regularly moving stimulus on their screen with their eyes. At pretest, the individual differences of cognitive self-affirmation inclination (CSAI) and gender were assessed to predict defensive reactions. Results: In Study 1, induced eye movements significantly increased self-reported consumption after 2 weeks when CSAI was low, but only in males, as indicated by a significant three-way interaction (p < 0.001). With negative self-evaluative emotions as dependent variable, this three-way interaction was also significant (p < 0.05), suggesting that induced eye movements prevented defensiveness in low CSAI males. Study 2 did not assess consumption but replicated the latter three-way interaction (p < 0.05). Conclusion: The studies replicated our earlier findings regarding the moderating effects of individual differences in emotion regulation (i.e., CSAI) on persuasion, but they also revealed gender differences in persuasion that are related to the working memory. The working memory account of persuasion provides new theoretical as well as practical angles on persuasion to target individuals in persuasion to increase fruit and vegetable consumption.
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Affiliation(s)
- Arie Dijkstra
- Faculty of Behavioural and Social Sciences, Department of Psychology, University of Groningen, Groningen, Netherlands
| | - Sarah P Elbert
- Faculty of Behavioural and Social Sciences, Department of Psychology, University of Groningen, Groningen, Netherlands
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Ferrer RA, Cerully JL, Harris PR, Klein WMP. Greater benefit of self-affirmation for prevention-focused individuals prior to threatening health messages. Psychol Health 2020; 36:719-738. [PMID: 32781845 DOI: 10.1080/08870446.2020.1800008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation's effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness. DESIGN In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk. MAIN OUTCOME MEASURES Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios. RESULTS In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003). CONCLUSION These findings demonstrate that health prevention-focus can strengthen self-affirmation's effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.
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Affiliation(s)
- Rebecca A Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | - Peter R Harris
- Department of Psychology, University of Sussex, Falmer, UK
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Neves FJ, Tomita LY, Liu ASLW, Andreoni S, Ramos LR. Educational interventions on nutrition among older adults: A systematic review and meta-analysis of randomized clinical trials. Maturitas 2020; 136:13-21. [PMID: 32386661 DOI: 10.1016/j.maturitas.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/29/2020] [Accepted: 03/07/2020] [Indexed: 12/12/2022]
Abstract
Poor nutrition is a major risk factor for non-communicable diseases and nutritional deficiencies. Dietary interventions have been proposed to improve eating habits. The aim of this systematic review is to evaluate the efficacy of randomized clinical trials of nutritional interventions in food habits among older people. A systematic literature review using the MEDLINE, LILACS, Scopus, Cochrane Library, Web of Science and Google Scholar databases was conducted, according to PRISMA guidelines. The keywords were: food and nutrition education OR educación alimentaria y nutricional OR educação alimentar e nutricional AND clinical trial OR ensayo clínico OR ensaio clínico AND elderly OR aged OR anciano OR idoso AND human OR seres humanos. The pooled standardized mean differences (SMD) and 95 % confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity among studies was assessed using I² tests. After screening based on the title and abstract, and a full-text assessment, 11 studies remained. Results of pooling eleven studies were as follows: SMD = 0.25 (95 % CI = 0.15 - 0.34; I² = 0,0%) for vegetable, SMD = 0.18 (95 % CI = 0.08 - 0.27; I² = 0,0%) for fruit and SMD = 0.27 (95 % CI = 0.18 - 0.36; I² = 58,3%) for fibre intake. Our results suggest that nutritional interventions were effective in increasing vegetable, fruit and fibre intake. However, these results should be analyzed carefully, due to the small number of studies included in the meta-analysis. Further studies should be encouraged due to the aging process.
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Affiliation(s)
- Felix Jesus Neves
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Luciana Yuki Tomita
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil.
| | - Angela Sun Li Wu Liu
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Solange Andreoni
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
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Ferrer RA, Cohen GL. Reconceptualizing Self-Affirmation With the Trigger and Channel Framework: Lessons From the Health Domain. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2018; 23:285-304. [DOI: 10.1177/1088868318797036] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Self-affirmation—a theory-based technique to affirm the adaptive adequacy of the self—can promote positive behavior change and adaptive outcomes, although effects are variable. We extend a novel framework (Trigger and Channel), proposing three conditions that facilitate self-affirmation-induced behavior change: (a) presence of psychological threat, (b) presence of resources to foster change, and (c) timeliness of the self-affirmation with respect to threat and resources. Using health behavior as a focus, we present meta-analytic evidence demonstrating that when these conditions are met, self-affirmation acts as a psychological trigger into a positive channel of resources that facilitate behavior change. The presence of a timely threat and the availability of timely resources independently predicted larger self-affirmation effects on behavior change, and the two interacted synergistically to predict still larger effects. The results illustrate the conditionality of self-affirmation effects and offer guidelines for when, where, and for whom self-affirmation will be most effective.
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Affiliation(s)
- Rebecca A. Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute, Bethesda, MD, USA
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Harris PR, Griffin DW, Napper LE, Bond R, Schüz B, Stride C, Brearley I. Individual differences in self-affirmation: Distinguishing self-affirmation from positive self-regard. SELF AND IDENTITY 2018. [DOI: 10.1080/15298868.2018.1504819] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Peter R. Harris
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Dale W. Griffin
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - Lucy E. Napper
- Department of Psychology, Health, Medicine, and Society Program, Lehigh University, Bethlehem, PA, USA
| | - Rod Bond
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Benjamin Schüz
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Christopher Stride
- Institute of Work Psychology, Management School, University of Sheffield, Sheffield, United Kingdom
| | - Irina Brearley
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Springer A, Venkatakrishnan A, Mohan S, Nelson L, Silva M, Pirolli P. Leveraging Self-Affirmation to Improve Behavior Change: A Mobile Health App Experiment. JMIR Mhealth Uhealth 2018; 6:e157. [PMID: 30026179 PMCID: PMC6072974 DOI: 10.2196/mhealth.9151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/12/2018] [Accepted: 04/24/2018] [Indexed: 12/28/2022] Open
Abstract
Background mHealth interventions can help to improve the physical well-being of participants. Unfortunately, mHealth interventions often have low adherence and high attrition. One possible way to increase adherence is instructing participants to complete self-affirmation exercises. Self-affirmation exercises have been effective in increasing many types of positive behaviors. However, self-affirmation exercises often involve extensive essay writing, a task that is not easy to complete on mobile platforms. Objective This study aimed to adapt a self-affirmation exercise to a form better suited for delivery through a mobile app targeting healthy eating behaviors, and to test the effect of differing self-affirmation doses on adherence to behavior change goals over time. Methods We examined how varied self-affirmation doses affected behavior change in an mHealth app targeting healthy eating that participants used for 28 days. We divided participants into the 4 total conditions using a 2×2 factorial design. The first independent variable was whether the participant received an initial self-affirmation exercise. The second independent variable was whether the participant received ongoing booster self-affirmations throughout the 28-day study. To examine possible mechanisms through which self-affirmation may cause positive behavior change, we analyzed three aspects of self-affirmation effects in our research. First, we analyzed how adherence was affected by self-affirmation exercises. Second, we analyzed whether self-affirmation exercises reduced attrition rates from the app. Third, we examined a model for self-affirmation behavior change. Results Analysis of 3556 observations from 127 participants indicated that higher doses of self-affirmation resulted in improved adherence to mHealth intervention goals (coefficient 1.42, SE 0.71, P=.04). This increased adherence did not seem to translate to a decrease in participant attrition (P value range .61-.96), although our definition of attrition was conservative. Finally, we examined the mechanisms by which self-affirmation may have affected intentions of behavior change; we built a model of intention (R2=.39, P<.001), but self-affirmation did not directly affect final intentions (P value range .09-.93). Conclusions Self-affirmations can successfully increase adherence to recommended diet and health goals in the context of an mHealth app. However, this increase in adherence does not seem to reduce overall attrition. The self-affirmation exercises we developed were simple to implement and had a low cost for both users and developers. While this study focused on an mHealth app for healthy eating, we recommend that other mHealth apps integrate similar self-affirmation exercises to examine effectiveness in other behaviors and contexts.
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Affiliation(s)
- Aaron Springer
- Palo Alto Research Center, Palo Alto, CA, United States.,Computer Science Department, University of California Santa Cruz, Santa Cruz, CA, United States
| | | | - Shiwali Mohan
- Palo Alto Research Center, Palo Alto, CA, United States
| | - Lester Nelson
- Palo Alto Research Center, Palo Alto, CA, United States
| | - Michael Silva
- Palo Alto Research Center, Palo Alto, CA, United States
| | - Peter Pirolli
- Palo Alto Research Center, Palo Alto, CA, United States
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