Nutrition and Physical Activity: Community-based Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity.

Community Preventive Services Task Force (CPSTF) (2020)

CPSTF - doi.org/10.15620/cdc/164245

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Evidence Categories

• Care setting: College/University Setting
• Care setting: Community setting
• Population group: General Population
• Population group: Older adults
• Population group: General population
• Intervention: Intra-/Inter-personal: Multicomponent programme remote
• Outcome: Healthy Eating: Energy intake
• Outcome: Healthy Eating: Fruit and veg intake
• Outcome: Healthy Eating: Fibre intake
• Outcome: Healthy Eating: Fat intake
• Outcome: Healthy Eating: Salt intake
• Outcome: Healthy Eating: Protein intake
• Outcome: Healthy Eating: Whole diet quality

Type of Evidence

Guidance

Overview

The systematic review, which underpins this CPSTF recommendation, provides evidence on the following topics:

• "Community-based digital health and telephone interventions to increase healthy eating and physical activity aim to support individuals who are interested in improving these behaviors."
• "Interventions are delivered in community settings through websites, mobile apps, text messages, emails, or one-on-one telephone calls. They include one or more of the following:
  • Coaching or counseling with trained professionals who provide personalized assistance related to eating and physical activity behaviors, or weight
  • Self-monitoring to record eating or physical activity behaviors, or weight
  • Goal setting related to eating or physical activity behaviors, or weight
  • Social support from peers through social media, internet forums, or discussion groups
  • Educational tools and resources designed to support healthy eating or physical activity (e.g., newsletter, handbook)
  • Motivational strategies that include incentives, rewards, prompts, and gaming techniques
  • Computer-generated feedback that provides tailored information based on performance (i.e., prompts, meeting goals, and adherence)."

The authors state:

• "The CPSTF recommendation is based on evidence from a review of 31 studies."
• "Included studies were conducted in the United States (15 studies), the Netherlands (6 studies), Australia (5 studies), Belgium (1 study), Canada (1 study), Israel (1 study), and the United Kingdom (1 study), and one study spanned multiple European countries."
• "Participants were recruited online or through print media distributed through various community settings such as faith-based organizations, institutions of higher education, or worksites (16 studies)."
• "Eighteen of the included studies reported participants’ overall diet quality index scores and their intake of total fat, salt, fiber, and meat. Ten studies (13 arms) reported a median relative improvement in participants’ dietary quality of 5.70% (IQI: -6.26% to 15.09%). Nine studies (13 arms) reported on saturated fat or total fat intake. Of these, four studies (6 arms) reported a median decrease in intake of 0.40 percentage points (IQI: -1.68 to 0.02), three reported favorable decreases, and two showed no change. Four studies reported inconsistent findings for both salt and fiber intake. Two studies reported meat intake; one reported a decrease in consumption, and the other reported no change."
• "Two studies that recruited older adults (60 years and over) reported inconsistent results for dietary, physical activity, and weight-related outcomes."
• "Fourteen studies reported socioeconomic status (SES) indicators and found similar effectiveness among low- and mixed-income populations."
• "The fifteen studies from the United States reported racial and ethnic distributions that demonstrated intervention effectiveness across groups."
• "Intervention duration ranged from two weeks to 12 months, with a median duration of 3.5 months. Most of the interventions were implemented for less than six months (22 studies) and reported similar effectiveness."
• "Interventions that use technology are a convenient way to reach individuals. They have the potential for broad dissemination and scalability (Carter et al., 2013; Roess, 2017; Svetkey et al., 2015)."
• "Digital health interventions may increase access for people who live in rural areas or have transportation challenges that make it difficult to attend in-person classes or programs."
• "The digital divide needs to be considered when using technology other than telephones to implement programs."
• "Implementers may want to consider the built environment around participants. It is important for participants to have access to healthier foods and safe places where they can be physically active."
• "Data security and privacy issues need to be considered when individuals enter personal information electronically."
• "Digital health is rapidly evolving. Newer digital health interventions, such as those that incorporate social media platforms, were not represented in this body of evidence."

Recommendations

Taking into consideration evidence and stakeholder input, the CPSTF recommends:

• "digital health and telephone interventions that are implemented in community settings and focus on improving healthy eating and physical activity among adults interested in improving these behaviors."
• "Evidence also shows participants increase their consumption of fruit and vegetables and decrease their consumption of total energy and energy-dense, nutrient-poor foods."