Computer-based nutrition education for adolescents: systematic review and focus on embedded videos

Despite our best efforts, the status of adolescent nutrition still does not meet recommendations. To better target the adolescent population, nutrition education is rapidly spreading into the world of technology. Unfortunately, it may be doing so at a faster rate than research can support. Computer-based nutrition education interventions are being utilized more frequently than in previous decades; however, there is a lack of research to support their overall efficacy and a lack of evaluation of which elements within the interventions deliver the greatest impact. First, a systematic review was conducted to evaluate the efficacy of computer-mediated nutrition education interventions for adolescents. A systematic literature search of research conducted within the past 10 years resulted in a final review of fourteen articles after application of inclusion and exclusion criteria. These studies were evaluated for their ability to achieve stated objectives and for quality using the United States Department of Agriculture Nutrition Evidence Library appraisal guidelines for Research Design and Implementation. Ten out of fourteen studies were randomized controlled trials, and most focused on elements of healthy eating (n=10), while fewer focused on changes in weight status (n=4). Most interventions were behaviorally focused with few measuring changes in nutrition knowledge (n=3). Approximately half of the interventions produced positive changes in nutrition-related variables. Health behavior theory emerged as a potentially important factor to producing desired effects, as the application of a theoretical framework was more highly associated with studies that resulted in statistically significant changes. However, these changes could not be attributed to an individual theory or combination of theories. The area of intensity, which includes dose and duration, as well as the areas of parental involvement and gender were identified as important areas for future research. Evaluation of the impact of parental involvement and skill-building strategies is required to provide evidence for their inclusion in future interventions. This review contributes to the understanding of current research in this area and will improve the results and applicability of future research. Second, to examine the efficacy of a video component within an online nutrition education intervention, a qualitative study was conducted using focus groups with middle-school students (6th to 8th grade, n=41). To compare differences in information delivery, the study used the Healthy Outcomes for Teens Project intervention containing 6 videos about nutrition and physical activity and included an alternate page consisting of textual versions of the same scenarios with voiceover narration. Following a crossover design, students viewed the video and narrated-text versions of the scenarios and participated in small focus groups of 2 to 6 students. Focus group responses were transcribed, coded, and analyzed for themes using the guidelines for thematic analysis. Students who first watched the videos recalled a greater number of scenarios without prompting, recalled more details about the scenarios, and used less forgetful phrases than those who listened to the narrated text. Broad, non-specific interpretations were provided in both the video and narration groups; however, about 70% responded with an interpretation that showed understanding of the nutritional message, with the video group providing a higher percentage of intended interpretations of the scenarios. After the crossover, the video-first group remembered a similar amount and described in similar detail the stories remembered; conversely, the narration-first group showed greater recall in both amount of stories recalled and details remembered. After the crossover, the groups lessened in the percentage of correct interpretations (53%), however, the video-first group provided a higher percentage of intended interpretations of the nutrition messages compared to the narration group. A similar amount of girls and boys reported that they would recommend the videos rather than the narrated text to their friends. These results indicate the possible advantage of nutrition education videos to improve recall and retention of nutrition information in adolescents and emphasize that straightforward, clear nutritional messaging may be important for increasing accurate comprehension of nutrition information by all adolescents