What is the effect of nutrition education delivered via digital media and/or technology on children’s dietary intake-related behaviors?
The use of digital media and/or technology, such as computers or Internet, for delivering education is increasing. The objective of this systematic review was to determine the effect of nutrition education delivered via digital media and/or technology on children’s and adolescents' dietary intake-related behavior.
Moderate evidence shows that nutrition education delivered via digital media/technology (computer- and Internet-based programs) may be effective for improving dietary intake-related behaviors among children and adolescents (Grade: Moderate).
Literature searches were conducted using PubMed, EBSCOhost, Education Fulltext, and Global Health to identify studies that tested the effects of nutrition education delivered using some type of digital media/technology (e.g., computer, internet) on dietary-intake related outcomes.
- Inclusion Criteria: Published between January 1995 and December 2010; conducted in subjects aged 0–18 years; randomized controlled trials, non-randomized controlled trials, or quasi-experimental studies; subjects from countries with high or very high human development (based on the Human Development Index); subjects who were healthy or at elevated chronic disease risk; published in English in a peer-reviewed journal
- Exclusion Criteria: Systematic reviews, meta-analyses, narrative reviews, or prospective cohort, cross-sectional, or case-control designs; studies with no control group; subjects hospitalized, diagnosed with disease, and/or receiving medical treatment.
The results of each included study were summarized in evidence worksheets (including a study quality rating), an evidence paragraph, and evidence table. A group of subject matter experts were involved in a qualitative synthesis of the body of evidence, development of a conclusion statement, and assessment of the strength of the evidence (grade) using pre-established criteria including evaluation of the quality, quantity, consistency, magnitude of effect and generalizability of available evidence.
- Twenty-four articles were included in this systematic review. Nineteen studies were randomized controlled trials and five were non-randomized controlled trials. Twelve studies received a positive quality rating (12 RCTs), and 12 studies received a neutral quality rating (seven RCTs, five non-RCTs)
- Twenty-one studies found that nutrition education delivered via digital media/technology significantly improved dietary intake-related behaviors
- Fifteen studies found that nutrition education delivered via digital media/technology was more effective than the no-intervention control or a comparison intervention with another type of nutrition education method
- Two studies found delivering nutrition education using digital media/technology or traditional methods were equally effective
- One study found that nutrition education delivered via digital media/technology improved dietary intake, but not more than the control/comparison
- Two studies found that nutrition education delivered via digital media/technology improved dietary intake in girls, but not in boys
- One study found that nutrition education delivered via digital media/technology was effective immediately following the intervention, but not six months post-intervention
- Three studies found no significant differences in dietary intake following nutrition education delivered via digital media/technology compared to a control or comparison intervention.
The ability to draw strong conclusions was limited due to the following issues:
- The large degree of variation in intervention design and study characteristics
- The field of digital media/technology is rapidly evolving
- The use of digital media/technology in the field of nutrition is novel.
In general, use of digital media/technology can ensure that interventions are delivered to a wide range of children in a variety of settings with high fidelity. In addition, using a theoretical framework that targets specific behaviors, and providing frequent doses of education over longer periods of time can help ensure that the intervention is successful. However, keeping students engaged is a challenge, and more research is needed to better understand the utility and effectiveness of using digital media/technology to deliver nutrition education.