235 lines
7.2 KiB
YAML
235 lines
7.2 KiB
YAML
abstract: 'Background: UK public health policy strongly advocates dietary change
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for the improvement of population health and emphasises the importance
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of individual empowerment to improve health. A new and evolving area in
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the promotion of dietary behavioural change is `e-learning'', the use of
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interactive electronic media to facilitate teaching and learning on a
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range of issues including health. The high level of accessibility,
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combined with emerging advances in computer processing power, data
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transmission and data storage, makes interactive e-learning a
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potentially powerful and cost-effective medium for improving dietary
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behaviour.
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Objective: This review aims to assess the effectiveness and
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cost-effectiveness of adaptive e-learning interventions for dietary
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behaviour change, and also to explore potential psychological mechanisms
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of action and components of effective interventions.
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Data sources: Electronic bibliographic databases (Cumulative Index to
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Nursing and Allied Health Literature, The Cochrane Library, Dissertation
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Abstracts, EMBASE, Education Resources Information Center, Global
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Health, Health Economic Evaluations Database, Health Management
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Information Consortium, MEDLINE, PsycINFO and Web of Science) were
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searched for the period January 1990 to November 2009. Reference lists
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of included studies and previous reviews were also screened; authors
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were contacted and trial registers were searched.
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Review methods: Studies were included if they were randomised controlled
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trials, involving participants aged >= 13 years, which evaluated the
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effectiveness of interactive software programs for improving dietary
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behaviour. Primary outcomes were measures of dietary behaviours,
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including estimated intakes or changes in intake of energy, nutrients,
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dietary fibre, foods or food groups. Secondary outcome measures were
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clinical outcomes such as anthropometry or blood biochemistry.
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Psychological mediators of dietary behaviour change were also
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investigated. Two review authors independently screened results and
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extracted data from included studies, with any discrepancies settled by
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a third author. Where studies reported the same outcome, the results
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were pooled using a random-effects model, with weighted mean differences
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(WMDs), and 95\% confidence intervals (CIs) were calculated.
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Cost-effectiveness was assessed in two ways: through a systematic
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literature review and by building a de novo decision model to assess the
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cost-effectiveness of a `generic'' e-learning device compared with
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dietary advice delivered by a health-care professional.
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Results: A total of 36,379 titles were initially identified by the
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electronic searches, of which 43 studies were eligible for inclusion in
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the review. All e-learning interventions were delivered in high-income
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countries. The most commonly used behavioural change techniques reported
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to have been used were goal setting; feedback on performance;
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information on consequences of behaviour in general; barrier
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identification/problem solving; prompting self-monitoring of behaviour;
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and instruction on how to perform the behaviour. There was substantial
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heterogeneity in the estimates of effect. E-learning interventions were
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associated with a WMD of +0.24 (95\% CI 0.04 to 0.44) servings of fruit
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and vegetables per day; -0.78g (95\% CI -2.5g to 0.95g) total fat
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consumed per day; -0.24g (95\% CI -1.44g to 0.96g) saturated fat intake
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per day; -1.4\% (95\% CI -2.5\% to -0.3\%) of total energy consumed from
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fat per day; +1.45g (95\% CI -0.02g to 2.92g) dietary fibre per day; +4
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kcal (95\% CI -85 kcal to 93 kcal) daily energy intake; -0.1 kg/m(2)
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(95\% CI -0.7 kg/m(2) to 0.4 kg/m(2)) change in body mass index. The
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base-case results from the E-Learning Economic Evaluation Model
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suggested that the incremental cost-effectiveness ratio was
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approximately 102,112 per quality-adjusted life-year (QALY). Expected
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value of perfect information (EVPI) analysis showed that although the
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individual-level EVPI was arguably negligible, the population-level
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value was between 37M pound and 170M pound at a willingness to pay of
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20,000-30,000 pound per additional QALY.
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Limitations: The limitations of this review include potential reporting
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bias, incomplete retrieval of completed research studies and data
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extraction errors.
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Conclusion: The current clinical and economic evidence base suggests
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that e-learning devices designed to promote dietary behaviour change
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will not produce clinically significant changes in dietary behaviour and
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are at least as expensive as other individual behaviour change
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interventions.
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Future work recommendations: Despite the relatively high EVPI results
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from the cost-effectiveness modelling, further clinical trials of
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individual e-learning interventions should not be undertaken until
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theoretically informed work that addresses the question of which
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characteristics of the target population, target behaviour, content and
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delivery of the intervention are likely to lead to positive results, is
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completed.'
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affiliation: 'Edwards, P (Corresponding Author), London Sch Hyg \& Trop Med, Fac Epidemiol
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\& Populat Hlth, London WC1, England.
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Harris, J.; Felix, L.; Ferguson, E.; Free, C.; Edwards, P., London Sch Hyg \& Trop
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Med, Fac Epidemiol \& Populat Hlth, London WC1, England.
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Miners, A.; Lock, K., London Sch Hyg \& Trop Med, Fac Publ Hlth \& Policy, London
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WC1, England.
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Murray, E., UCL, Res Dept Primary Care \& Populat Hlth, London, England.
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Michie, S., UCL, Res Dept Clin Educ \& Hlth Psychol, London, England.
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Landon, J., Natl Heart Forum, London, England.'
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author: Harris, J. and Felix, L. and Miners, A. and Murray, E. and Michie, S. and
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Ferguson, E. and Free, C. and Lock, K. and Landon, J. and Edwards, P.
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author_list:
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- family: Harris
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given: J.
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- family: Felix
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given: L.
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- family: Miners
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given: A.
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- family: Murray
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given: E.
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- family: Michie
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given: S.
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- family: Ferguson
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given: E.
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- family: Free
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given: C.
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- family: Lock
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given: K.
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- family: Landon
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given: J.
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- family: Edwards
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given: P.
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da: '2023-09-28'
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doi: 10.3310/hta15370
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eissn: 2046-4924
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files: []
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issn: 1366-5278
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journal: HEALTH TECHNOLOGY ASSESSMENT
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keywords-plus: 'TAILORED NUTRITION INTERVENTION; FAT INTAKE INTERVENTION; REDUCING
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RISK-FACTORS; PHYSICAL-ACTIVITY; RANDOMIZED-TRIAL; WEIGHT-LOSS;
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VEGETABLE CONSUMPTION; CARDIOVASCULAR RISK; SMOKING-CESSATION;
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SELF-EFFICACY'
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language: English
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month: OCT
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number: '37'
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number-of-cited-references: '122'
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orcid-numbers: 'Michie, Susan/0000-0003-0063-6378
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Edwards, Phil/0000-0003-4431-8822
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Murray, Elizabeth/0000-0002-8932-3695
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Harris, Jody/0000-0002-3369-1253
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Felix, Lambert/0000-0001-6517-9089
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Free, Caroline/0000-0003-1711-0006'
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pages: 1+
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papis_id: ebc10dbd9ee3d9e0fb30bb6cdb58f96e
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ref: Harris2011adaptiveelearning
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researcherid-numbers: 'Michie, Susan/A-1745-2010
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'
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times-cited: '56'
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title: 'Adaptive e-learning to improve dietary behaviour: a systematic review and
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cost-effectiveness analysis'
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type: article
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unique-id: WOS:000300462800001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '77'
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volume: '15'
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web-of-science-categories: Health Care Sciences \& Services
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year: '2011'
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