Computer-Tailored Health Messages Change Eating Habits

Personalized education messages may nudge people toward healthier habits, according to a new review of studies. The analysis found that computer-tailored health education is especially effective in helping people cut the fat in their diet and eat more fruits and vegetables.

The results suggest that customized health education beats out generic advice, said Johannes Brug, a researcher at the Erasmus University Medical Center in the Netherlands.

To get a tailored health message, participants fill out a survey to document different aspects of their lifestyle from food and exercise to whether they smoke. Next, a computer uses the collected information to generate advice or a health plan. Sometimes the results come in letter form, sometimes packaged to look like a brochure.

"Each and every individual gets a personal, relevant nutrition education or physical activity message that only applies to him or her,” said Brug, a review co-author.

The analysis of studies, which appears in the June edition of the Annals of Behavioral Medicine, gathers data from 30 different studies with as few as 84 participants and as many as 1317.

A majority of studies found that the groups who received personalized advice increased their daily servings of fruits and vegetables. Eleven of the 14 studies that tested the short-term effect of tailored education on fat intake showed a significant improvement in the participants’ diet. Among the 11 studies with strong results, six compared tailored information against no information, while four studies tested personalization against generic education and one study tested tailored feedback against results after a video lecture.

“If you have the choice between a generic message or the computer-tailored message, go with the computer tailored message because that will help you more,” Brug said.

Review co-author Willemieke Kroeze said custom health education had some positive effects on participants’ physical activity, but those results were less consistent or convincing than the changes in diet.

Custom, computer-generated health education may have power to improve public health, Brug said. “In all market-economy countries, health behavior is the main determinant of population health. So changing these behaviors should be the main focus of public health professionals,” he added. “We need good tools to be able to change those behaviors.”

The programs are not widely available now, but the Netherlands’ heart foundation has adopted a Web system that allows people to check their risk for cardiovascular disease, and then get personalized advice about adopting health-promoting behavior, Brug said.

In the United States one manufacturer of stop-smoking aids - nicotine patches and gum - uses a similar program to steer potential consumers to the products best suited for their habits and lifestyle.

“If your doctor wanted you to quit smoking, he could prescribe the aid and direct you to that Web site, and you could get the tailored materials,” said Marci Campbell, a health-behavior researcher at the University of North Carolina. Campbell is familiar with the new review, but did not work on the analysis.

Today most of the customized health advice begins with a paper-and-pencil survey and ends with results on paper. But private companies and university-based teams are developing Web-based programs that collect lifestyle information online and deliver the health education online too.

Campbell said the Web may be an optimal way to reach people and gather their data. But, she said, some research is fueling controversy about health feedback delivered through the computer.

“Certain studies have shown that the same dose of a print intervention has more effect than a Web intervention,” Campbell said.

“There may also be other types of technologies, automated interactive systems, like cell phones, that might be better for certain types of people,” she said.

Researchers and program designers need to pay attention to which technology people are most comfortable with and how they learn best, Campbell added.

Annals of Behavioral Medicine is the official peer-reviewed publication of The Society of Behavioral Medicine. For information about the journal, contact Alan J. Christensen, Ph.D., at (319) 335-3396.

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