Development and Preliminary Evaluation of an Internet-Based Healthy Eating Program: Randomized Controlled Trial

Background The HealthValues Healthy Eating Programme is a standalone Internet-based intervention that employs a novel strategy for promoting behavior change (analyzing one’s reasons for endorsing health values) alongside other psychological principles that have been shown to influence behavior. The program consists of phases targeting motivation (dietary feedback and advice, analyzing reasons for health values, thinking about health-related desires, and concerns), volition (implementation intentions with mental contrasting), and maintenance (reviewing tasks, weekly tips). Objective The aim was to examine the effects of the program on consumption of fruit and vegetables, saturated fat, and added sugar over a 6-month period. Methods A total of 82 females and 18 males were recruited using both online and print advertisements in the local community. They were allocated to an intervention or control group using a stratified block randomization protocol. The program was designed such that participants logged onto a website every week for 24 weeks and completed health-related measures. Those allocated to the intervention group also completed the intervention tasks at these sessions. Additionally, all participants attended laboratory sessions at baseline, 3 months, and 6 months. During these sessions, participants completed a food frequency questionnaire (FFQ, the Block Fat/Sugar/Fruit/Vegetable Screener, adapted for the UK), and researchers (blind to group allocation) measured their body mass index (BMI), waist-to-hip ratio (WHR), and heart rate variability (HRV). Results Data were analyzed using a series of ANOVA models. Per protocol analysis (n=92) showed a significant interaction for fruit and vegetable consumption (P=.048); the intervention group increased their intake between baseline and 6 months (3.7 to 4.1 cups) relative to the control group (3.6 to 3.4 cups). Results also showed overall reductions in saturated fat intake (20.2 to 15.6 g, P<.001) and added sugar intake (44.6 to 33.9 g, P<.001) during this period, but there were no interactions with group. Similarly, there were overall reductions in BMI (27.7 to 27.3 kg/m2, P=.001) and WHR (0.82 to 0.81, P=.009), but no interactions with group. The intervention did not affect alcohol consumption, physical activity, smoking, or HRV. Data collected during the online sessions suggested that the changes in fruit and vegetable consumption were driven by the motivational and maintenance phases of the program. Conclusions Results suggest that the program helped individuals to increase their consumption of fruit and vegetables and to sustain this over a 6-month period. The observed reduction in fat and sugar intake suggests that monitoring behaviors over time is effective, although further research is needed to confirm this conclusion. The Web-based nature of the program makes it a potentially cost-effective way of promoting healthy eating.

As a token of our appreciation, and to cover any travel expenses incurred, you will receive £10 upon completion of the first lab session, £25 upon completion of the second lab session and £50 upon completion of the third lab session. You will also accrue small amounts (to a total of £65) for each web session you complete. This money will be given to you at the third lab session. What will the heart-rate measure tell you? This measure will give us a very general indication of cardiac fitness. It is not a clinical assessment and thus will not identify any clinically significant heart rhythm problems. What happens if I'm allocated to the 'monitoring' group? You will be asked to attend the three lab sessions and log into the website on a weekly basis for 24 weeks. The website sessions will contain questionnaires to help monitor health. Monitoring health behaviours has been shown to be a useful tool for reaching health goals. At the end of the 24 weeks we will offer you the opportunity to also complete the additional tasks should you wish to do so.

What happens if I'm allocated to the 'experimental' group?
You will be asked to attend the three lab sessions and log into the website on a weekly basis for 24 weeks. The website sessions will give you access to the new health--related tasks that you will be asked to complete alongside the questionnaire measures. What does the healthy eating programme consist of? The programme consists of four main parts. In Part 1 we give you some feedback about your diet, along with some general dietary advice. In Part 2 we ask you to think a bit more deeply about health--related issues. In Part 3 we ask you to make specific plans to change particular behaviours. Finally, in Part 4 we give you options to repeat tasks, work on more plans and view weekly tips. All the sessions employed in the programme are based on psychological principles that have been shown to help individuals change their behaviour. What kind of dietary feedback will you give me? We will use some of the information you give us to provide you with estimates of your intake of fruit and vegetables, saturated fat and added sugar. However, it is important to be aware that these are only estimates, the accuracy of which may be influenced by a range of different factors. If you are concerned about your health, or the feedback you receive from the programme, you should contact your GP. What type of health advice will you give me? We will provide you with very general dietary advice. Again, if you have any concerns about your diet or your health it is important that you consult your GP. If you suffer from any conditions that effect your diet (e.g., pregnancy, diabetes, eating disorder), it is also important that you consult with your GP before making any changes.

Will the programme help me lose weight?
Whilst the programme has not been designed as a weight loss tool, the changes it advocates (i.e. eating more fruit and vegetables and less saturated fat and added sugar) are compatible with weight loss goals. As such we hope that individuals who are trying to lose weight will find it helpful. What types of questionnaires will I complete online? The questionnaires mainly relate to health behaviours such as diet and exercise. There are also some personality questionnaires. Additionally we ask you to provide some background information about yourself. I only want to take part if I can complete the experimental healthy eating programme. Should I still sign up? Unfortunately, in order to evaluate the programme properly, it is important that participants are randomly assigned to the 'experimental' or 'monitoring' group. For this reason, we cannot guarantee that you will be allocated to the experimental group. You will have a 50% chance of being allocated to this group. In other words, if 100 people sign up, we will ask 50 of them to complete the experimental programme. We appreciate that this makes your decision more difficult and hope that you won't be too disappointed should you not be asked to complete the programme. However, in order to evaluate the programme properly, it is also important that people don't change their minds about participating. For this reason we ask that you only sign up if you are prepared to be in either the 'experimental' or 'monitoring' group.

What happens if I sign up then change my mind?
It is important that you only sign up if you are willing and able to complete the three lab sessions and 24 weekly online sessions. However, should things change once you have signed up you are free to withdraw at any time. Simply contact a member of the HealthValues team on 07950 136663 or at healthvalues@swansea.ac.uk What will happen to the information you collect? All information collected will be confidential and will be kept securely in strict accordance with the Data Protection Act. It will not be used for any other purpose. An analysis of the information will form part of our report at the end of the study and may be presented to interested parties and published in scientific journals and related media.

What if there is something I don't understand or if I have further questions?
Please contact a member of the HealthValues team who will be very happy to discuss the project further with you. They can be reached on 07950 136663 or at healthvalues@swansea.ac.uk