Assessing the effectiveness of web technologies to promote healthy living in children: a randomized controlled trial

Abstract

Background: Energy-dense high fat dietary intakes and low levels of physical activity among children are considered to be significant contributing factors in the development of excessive weight gain issues leading to overweight and obesity. The rapid increase of obesity and overweight is a global concern. Australia has one of the fastest growth rates of overweight and obesity in the world. It is reported that one in five children in Australia is obese or overweight. Therefore, effective preventive measures in childhood obesity have been identified as an urgent need to address this problem. E-Health has shown its potential to provide effective alternative ways in care delivery, disease prevention and management in relation to various health problems. Aims: The main aim of this study is to investigate the effect of web-based intervention to promote healthy lifestyles among children focusing on healthy eating and exercise habits. Specifically this study aims to assess the feasibility and effectiveness of a web-based intervention that delivers health messages and information. It also aims to assess the differences in the outcomes provided by the web-based intervention in terms of improving knowledge and healthy behaviour relating to healthy eating and physical activity practices. Methods: To inform the design and content of the trial it was necessary to systematically review all literature relating to the effectiveness of web-based health promotion interventions for physical activity and nutritional outcomes. The effectiveness of the intervention was evaluated through a randomized controlled trial carried out in children aged 8 – 14 years. A total of 65 randomized participants were allocated either to the web intervention or to the control group. Participants in the intervention group were given access to explore the healthy living web-based program for 16 weeks, with the first eight weeks of the intervention being guided by the principle investigator. The participants in the control group were not given access to web-based program. They were asked to continue their usual daily life activities. The effects of intervention were evaluated at eight weeks post-assessment. The sustained effects of the intervention were examined at the eight-week follow-up. The primary outcomes measures included the changes in the participants’ level of knowledge in healthy eating and physical activity and changes in dietary and exercise behaviour. Results: The findings indicated that statistically significant differences between groups were shown in the level of nutritional knowledge; however, the increase in the knowledge scores across time was similar within each group (baseline: (MD) = 2.06; 95% CI: 0.65 to 3.48; P=0.005, 8-week post trial: MD=2.18; 95%CI: 0.99 to 3.38; P=0.001 and; 16-week follow-up: MD=3.91; 95% CI: 2.14 to 5.67; P=0.002). The level of fruit and vegetables intake and the level of physical activity had shown no significant differences between groups at all time-points. However, findings indicated that children in the intervention group had higher percentage in meeting requirement of fruit and vegetables intake level (OR=1.50; 95% CI: 0.33 to 6.82; P=0.72) and physical activity level (OR=2.81; 95% CI: 0.89 to 8.88; P=0.08) at eight week post trial. At 16-week follow-up, both groups reported that majority of the participants (91%) meeting the requirement of eating fruit and vegetables (OR=1.0; 95% CI: 0.05 to 18.3; P = 1.0) and 73% children in the intervention group were reported to meet the physical activity requirements compared to the control group (OR=7.1; 95% CI: 1.09 to 46.44, P=0.09). In terms of psychological factors, self-efficacy and barriers to change to adopt healthy practices had shown a significant difference between groups at post-intervention (MD=2.59; 95% CI: 1.26 to 3.93; P=0.0003 and MD=3.50; 95% CI: 2.02 to 4.99; P<0.001, respectively). Conclusions: Overall, the present research study suggested that the web interventions increased both physical activity and fruit and vegetable intake, but the increase was not statistically significant within the two month period. The results demonstrated that the use of web technology raised self-efficacy and reduced barriers to adopting healthy practices. The increase in knowledge scores was shown at all time-points, therefore the effect of the use of web technology should be cautiously acknowledged. Limitations of the study include the small sample size, the short duration of the web intervention and the lack of engagement in the web-based program. Thus, more research evaluating the effect of web intervention over longer duration with a larger and more representative sample of participants is required. Further research exploring potential strategies that encourage engagement of participants to the use of the web-based program also needs to be explored.