Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis

Area of Science:

• Health Technology Assessment
• Behavioural Science
• Public Health Policy

Background:

• UK public health policy promotes dietary change and individual empowerment for better health.
• E-learning, using interactive electronic media, is an emerging area for health promotion.
• Advances in technology make e-learning a potentially powerful and cost-effective tool for dietary behavior modification.

Purpose of the Study:

• To assess the effectiveness and cost-effectiveness of adaptive e-learning for dietary behavior change.
• To explore psychological mechanisms and components of effective e-learning interventions.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) published between January 1990 and November 2009.
• Inclusion criteria: RCTs, participants aged ≥13 years, evaluating interactive software for dietary behavior change.
• Data synthesis using random-effects models; cost-effectiveness assessed via literature review and a decision model.

Main Results:

• 43 studies included; all interventions in high-income countries. Commonly used techniques: goal setting, feedback, self-monitoring.
• E-learning showed minor effects on fruit/vegetable intake (+0.24 servings/day) and fat intake (-1.4% of energy).
• Cost-effectiveness analysis indicated an incremental cost of £102,112 per quality-adjusted life-year (QALY).

Conclusions:

• E-learning interventions for dietary behavior change do not currently yield clinically significant improvements.
• These interventions are at least as expensive as other individual behavior change methods.
• Further clinical trials are not recommended until theoretically informed research identifies key characteristics for effective interventions.