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      The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults

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          Abstract

          Background

          Early adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18–30 years).

          Methods

          A three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves.

          Results

          Young adults ( n = 247) were randomized to group A ( n = 82), group B ( n = 83), or group C ( n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg ( P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day ( P = .02). Women who received dietary feedback only significantly reduced their intake of SSB ( P = .04) by an average of 0.2 serves/day compared with controls.

          Conclusions

          Tailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults.

          Trial Registration

          Australian Clinical Trials Registry Registration number: ACTRN12612000250831.

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          Most cited references36

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          Understanding tailoring in communicating about health.

          'Tailoring' refers to any of a number of methods for creating communications individualized for their receivers, with the expectation that this individualization will lead to larger intended effects of these communications. Results so far have been generally positive but not consistently so, and this paper seeks to explicate tailoring to help focus future research. Tailoring involves either or both of two classes of goals (enhancing cognitive preconditions for message processing and enhancing message impact through modifying behavioral determinants of goal outcomes) and employs strategies of personalization, feedback and content matching. These goals and strategies intersect in a 2 x 3 matrix in which some strategies and their component tactics match better to some goals than to others. The paper illustrates how this framework can be systematically applied in generating research questions and identifying appropriate study designs for tailoring research.
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            A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors.

            Although computer-tailored promotion of dietary change and physical activity has been identified as a promising intervention strategy, there is a need for a more systematic evaluation of the evidence. This study systematically reviews the scientific literature on computer-tailored physical activity and nutrition education. Intervention studies published from 1965 up to September 2004 were identified through a structured search in PubMed, PsycInfo, and Web of Science and an examination of reference lists of relevant publications. Studies were included that applied a pretest-posttest randomized-controlled trial design, were aimed at primary prevention among adults, used computer-tailored interventions to change physical activity and dietary behaviors, and were published in English. The search resulted in 30 publications-11 on physical activity behaviors and 26 on nutrition behaviors, some studies investigated multiple behaviors. Three of 11 of the physical activity studies and 20 of 26 of the nutrition studies found significant effects of the tailored interventions. The evidence was most consistent for tailored interventions on fat reduction. Overall, there seems to be potential for the application of computer tailoring for promoting healthy diets, but more research is needed to test computer-tailored interventions against other state-of-the-art intervention techniques and to identify the mechanisms underlying successful computer tailoring.
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              Strengthening of accountability systems to create healthy food environments and reduce global obesity.

              To achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible for delivering effective actions and what, specifically, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fiscal interventions and soft voluntary, education-based approaches. Genuine progress lies beyond the impasse of these entrenched dichotomies. We argue for a strengthening of accountability systems across all actors to substantially improve performance on obesity reduction. In view of the industry opposition and government reluctance to regulate for healthier food environments, quasiregulatory approaches might achieve progress. A four step accountability framework (take the account, share the account, hold to account, and respond to the account) is proposed. The framework identifies multiple levers for change, including quasiregulatory and other approaches that involve government-specified and government-monitored progress of private sector performance, government procurement mechanisms, improved transparency, monitoring of actions, and management of conflicts of interest. Strengthened accountability systems would support government leadership and stewardship, constrain the influence of private sector actors with major conflicts of interest on public policy development, and reinforce the engagement of civil society in creating demand for healthy food environments and in monitoring progress towards obesity action objectives.
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                Author and article information

                Contributors
                61892664122 , D.Kerr@curtin.edu.au
                amelia.harray@curtin.edu.au
                c.pollard@curtin.edu.au
                S.Dhaliwal@curtin.edu.au
                ace@ecn.purdue.edu
                p.howat@curtin.edu.au
                M.Pickering@adfa.edu.au
                zahmad@purdue.edu
                rosie.meng@flinders.edu.au
                SPratt@cancerwa.asn.au
                J.Wright@exchange.curtin.edu.au
                k.kerr@curtin.edu.au
                CJBoushey@cc.hawaii.edu
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                21 April 2016
                21 April 2016
                2016
                : 13
                : 52
                Affiliations
                [ ]School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA 6845 Australia
                [ ]Public Health Division, Department of Health In Western Australia, 189 Royal Street, East Perth, 6004 WA Australia
                [ ]Video and Image Processing Laboratory, School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN USA
                [ ]School of Engineering and Information Technology, The University of New South Wales at the Australian Defence Force Academy, Canberra, Australia
                [ ]School of Medicine, Flinders University, Bedford Park, Australia
                [ ]Cancer Council Western Australia, Subiaco, WA Australia
                [ ]Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI USA
                [ ]Department of Nutrition Science, Purdue University, West Lafayette, IN USA
                Article
                376
                10.1186/s12966-016-0376-8
                4839101
                27098449
                c2015be4-d34d-4ce3-941e-88693da44141
                © Kerr et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 October 2015
                : 13 April 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000960, Healthway;
                Award ID: 18932
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/501100006065, Department of Health, Government of Western Australia;
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Nutrition & Dietetics
                mobile food record,novel technology,dietary assessment,interventions,text messaging,young adult,tailoring,energy-dense nutrient poor foods,sugar-sweetened beverages,fruit,vegetables,junk food

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