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

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Abstract

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.

Introduction

Diet is considered important in the prevention and control of various chronic diseases including cardiovascular disease, diabetes and cancer. High intakes of total and saturated fat, and low intakes of fruit and vegetables are, for example, associated with increased risk for cardiovascular disease and certain cancers [1]. In many Western countries, nutritional recommendations have been established for healthy individuals in order to decrease their risk for chronic disease. Recommendations have also been formulated for high risk groups, like people with elevated serum cholesterol levels or high blood pressure, and patients with conditions such as diabetes mellitus or cardiovascular disease. Despite these recommendations, however, many people consume too much fat and too few fruits and vegetables.

Because many people need to change their diets, dietary interventions to improve public health should have the potential to reach populations using (cost)-effective approaches. In a review of the literature on effectiveness of nutrition education, three criteria for effective dietary interventions were outlined [2]: (1) attention should be given to motivators and reinforcers that are personally relevant to the people in the target group, (2) personalized self-evaluation or self-assessment techniques should be used, and (3) people in the target group should have the opportunity to actively participate in the intervention. Interpersonal counseling and education, based on empirical knowledge about the behavioral change process and tailored to specific needs of individuals, was especially effective in promoting dietary change [2]. Face-to-face counseling, however, is relatively expensive and time consuming since it requires well trained counselors and person to person, or small group sessions. In some countries such as the USA and the Netherlands, one-to-one nutrition counseling is typically offered to individuals with diagnosed conditions such as diabetes, for which nutrition therapy is reimbursed by insurers. Because of the scarcity of nutrition professionals and the cost of counseling visits, it is doubtful that interpersonal nutrition counseling could be available and accessible to large, healthy population groups to stimulate adoption of dietary changes for disease prevention.

Attempts have been made to make mass media health education interventions more personally relevant for individuals in the target population. A basic way of tailoring health education is target group segmentation, with development of interventions for different target audiences [3]. Target group segmentation is most often based on socio-demographic variables such as sex, age, or socio-economic status, but there are also examples in which psychosocial characteristics, such as stages of change or health beliefs, have been used to divide the target population in different groups for which specific intervention activities were provided 4, 5, 6, 7.

Interventions that are designed for certain target group segments still do not account for personal differences in intervention needs among individuals of a target population. In recent years, computer programs have been developed, especially in the USA, that enable provision of personally tailored feedback for members of relatively large target populations. In this article, the process of providing people with computer-assisted personalized dietary feedback will be described and the research literature on so-called computer-tailored nutrition education will be reviewed.

Section snippets

Computer-tailoring

The use of computers to tailor health education messages to characteristics of individuals has been applied to various health related behaviors, most often in smoking cessation interventions 8, 9, 10, but also to increase participation in breast cancer screening [11], and to help people to adopt healthier diets 12, 13. Although it lacks the direct social support and social interaction components of interpersonal counseling, computer-tailored nutrition education mimics some attributes of

Examples of computer-generated nutrition education

A number of studies have reported on the practical applicability and impact of computer-generated nutrition education. Although the interventions that have been studied to date all provide the participants with some sort of individual feedback generated with computer assistance, there are large differences between these interventions based on the goals of the intervention, the variables that were tailored, whether behavior change theories were used to develop the interventions, which

The results of computer-tailored nutrition education interventions

A limited number of studies have used theoretical insights from social psychology models of behavior change to develop a computer-tailored nutrition intervention which included psychological feedback. These studies are summarized in Table 1 and will be described in order of year of publication, but closely related studies will be described together.

Burnett et al. [25]studied the impact of a computer-tailored weight reduction intervention as compared to two active control conditions. The authors

Discussion

Computer-tailored nutrition education has been implemented and studied in different target groups and settings for different dietary behaviors, and with different types of feedback. The rationale for tailored nutrition education is based on the assumption that responding to individual dietary behavior, needs and beliefs of subjects in the target population, will increase message relevance and therefore result in higher attention and motivational impact. From research included in the present

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