title: Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial.
abstract: 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/m(2), 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.
authors.affiliation: Department of Psychology, City University London, London, United Kingdom. katy.tapper.1@city.ac.uk.
authors.forename: Katy
authors.identifier: http://orcid.org/0000-0001-9097-6311
authors.initials: K
authors.lastname: Tapper
authors.forename: Gabriela
authors.identifier: http://orcid.org/0000-0003-3163-8798
authors.initials: G
authors.lastname: Jiga-Boy
authors.forename: Gregory R
authors.identifier: http://orcid.org/0000-0001-5408-5829
authors.initials: GR
authors.lastname: Maio
authors.forename: Geoffrey
authors.identifier: http://orcid.org/0000-0001-5293-2772
authors.initials: G
authors.lastname: Haddock
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-6709-9215
authors.initials: M
authors.lastname: Lewis
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004032:Diet; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet; D008297:Male; D009042:Motivation; D014675:Vegetables
keywords: Internet; added sugar; diet; fruit; health promotion; motivation; psychology; saturated fat; social values; vegetables