Preventing the obesity epidemic by second generation tailored health communication: an interdisciplinary review.
BACKGROUND
The prevention of obesity and health concerns related to obesity are major challenges worldwide. The use of eHealth communication and the tailoring of information delivered via the Internet at the individual level may increase the effectiveness of interventions. Mastering behaviors related to nutrition, physical activity, and weight management are the main issues in preventing obesity, and the need for interdisciplinary knowledge within this area is obvious.


OBJECTIVE
The objectives were to review the literature on tailored health communication and to present an interdisciplinary analysis of studies on "second" generation tailored interventions aimed at behavior change in nutrition, physical activity, or weight management.


METHODS
A literature search was conducted of the main electronic information sources on health communication. Selection criteria were defined, and 23 intervention studies were selected. The content analysis focused on the following: study designs, objectives of behavior change, target groups, sample sizes, study lengths, attrition rates, theories applied, intervention designs, computer-based channels used, statistically significant outcomes from the perspective of tailoring, and possible biases of the studies. However, this was not a structured meta-analysis and cannot be replicated as such.


RESULTS
Of the 23 studies, 21 were randomized controlled trials, and all focused on behavior change: 10 studies focused on behavior change in nutrition, 7 on physical activity, 2 on nutrition and physical activity, and 4 on weight management. The target groups and the number of participants varied: 8 studies included more than 500 participants, and 6 studies included less than 100. Most studies were short; the duration of 20 studies was 6 months or less. The Transtheoretical Model was applied in 14 of the 23 studies, and feedback as a tailoring mechanism was used in addition to an Internet site (or program) in 15 studies and in addition to email in 11 studies. Self-reporting was used in 15 studies, and 14 studies did not have a no-information control group. Tailoring was more effective in nutrition interventions than in physical activity and weight management interventions. The outcomes were mixed or negative in 4 studies of physical activity interventions and in 3 studies of weight management. The use of a no-information control group seemed to have been linked to statistically significant between-group effects in measuring physical activity. This bias effect related to intervention design may explain the differences in the outcomes of the physical activity studies.


CONCLUSIONS
Tailoring was shown to have been an effective method in nutrition interventions, but the results for physical activity were mixed, which is in line with previous studies. Nevertheless, the effect of possible biases, such as relying solely on self-reports and on intervention design without a no-information control group, should not be underestimated. Thus, the issue of bias merits more attention in planning interventions and in future meta-analyses.
Enwald
Heidi Päivyt Karoliina
HP
Finnish Information Studies and Logopedics, Centre of Excellence in Research, Faculty of Humanities, University of Oulu, Oulu, Finland.
Huotari
Maija-Leena Aulikki
ML
D003144:Communication Barriers; D003194:Computer-Assisted Instruction / Q000379:methods; D004038:Diet, Reducing / Q000379:methods; D004196:Disease Outbreaks / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008960:Models, Psychological; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods*; D012107:Research Design