An SMS chatbot digital educational program to increase healthy eating behaviors in adolescence: A multifactorial randomized controlled trial among 7,890 participants in the Danish National Birth Cohort.

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-06-14 eCollection Date: 2024-06-01 DOI:10.1371/journal.pmed.1004383
Anne Ahrendt Bjerregaard, Daniel E Zoughbie, Jørgen Vinsløv Hansen, Charlotta Granström, Marin Strøm, Þórhallur Ingi Halldórsson, Inger Kristine Meder, Walter Churchill Willett, Eric L Ding, Sjúrður Fróði Olsen
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We also explored possible added effects of maternal or peer involvement.</p><p><strong>Methods and findings: </strong>We conducted a randomized controlled trial (RCT) among adolescents from the Danish National Birth Cohort (DNBC). Eligible were adolescents who during 2015 to 2016 at age 14 years had completed a questionnaire assessing height, weight, and dietary habits. Two thirds were offered participation in an SMS-program, whereas 1/3 (\"non-SMS group\") received no offer. The SMS program aimed to improve 3 key dietary intake behaviors: sugar-sweetened beverages (SSBs), fruit and vegetables (FV), and fish. The offered programs had 3 factorially randomized schemes; the aims of these were to test effect of asking the mother or a friend to also participate in the health promotion program, and to test the effect of a 4-week individually tailored SMS program against the full 12-week SMS program targeting all 3 dietary factors. Height and weight and intakes of SSB, FV, and fish were assessed twice by a smartphone-based abbreviated dietary questionnaire completed at 6 months (m) and 18 m follow-up. Main outcome measures were (1) body mass index (BMI) z-score; and (2) an abbreviated Healthy Eating Index (mini-HEI, 1 m window, as mean of z-scores for SSB, FV, and fish). Among the 7,890 randomized adolescents, 5,260 were assigned to any SMS program; 63% (3,338) joined the offered program. Among the 7,890 randomized, 74% (5,853) and 68% (5,370) responded to follow-ups at 6 m and 18 m, respectively. Effects were estimated by intention-to-treat (ITT) analyses and inverse probability weighted per-protocol (IPW-PP) analyses excluding adolescents who did not join the program. Mean (standard deviation (SD)) mini-HEI at baseline, 6 m and 18 m was -0.01 (0.64), 0.01 (0.59), and -0.01 (0.59), respectively. In ITT-analyses, no effects were observed, at any time point, in those who had received any SMS program compared to the non-SMS group, on BMI z-score (6 m: -0.010 [95% confidence interval (CI) -0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI -0.029, 0.033]; p = 0.901) or mini-HEI (6 m: 0.016 [95% CI -0.011, 0.043]; p = 0.253, 18m: -0.016 [95% CI -0.045, 0.013]; p = 0.286). In IPW-PP analyses, at 6 m, a small decrease in BMI z-score (-0.030 [95% CI -0.057, -0.003]; p = 0.032) was observed, whereas no significant effect was observed in mini-HEI (0.027 [95% CI -0.002, 0.056]; p = 0.072), among those who had received any SMS program compared to the non-SMS group. At 18 m, no associations were observed (BMI z-score: -0.006 [95% CI -0.039, 0.027]; p = 0.724, and mini-HEI: -0.005 [95% CI -0.036, 0.026]; p = 0.755). 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Future research should focus on developing gender-specific messaging programs including \"booster\" messages to obtain sustained engagement.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier: NCT02809196 https://clinicaltrials.gov/study/NCT02809196.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":null,"pages":null},"PeriodicalIF":15.8000,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11178212/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PLoS Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1371/journal.pmed.1004383","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Few cost-effective strategies to shift dietary habits of populations in a healthier direction have been identified. We examined if participating in a chatbot health education program transmitted by Short Messages Service ("SMS-program") could improve adolescent dietary behaviors and body weight trajectories. We also explored possible added effects of maternal or peer involvement.

Methods and findings: We conducted a randomized controlled trial (RCT) among adolescents from the Danish National Birth Cohort (DNBC). Eligible were adolescents who during 2015 to 2016 at age 14 years had completed a questionnaire assessing height, weight, and dietary habits. Two thirds were offered participation in an SMS-program, whereas 1/3 ("non-SMS group") received no offer. The SMS program aimed to improve 3 key dietary intake behaviors: sugar-sweetened beverages (SSBs), fruit and vegetables (FV), and fish. The offered programs had 3 factorially randomized schemes; the aims of these were to test effect of asking the mother or a friend to also participate in the health promotion program, and to test the effect of a 4-week individually tailored SMS program against the full 12-week SMS program targeting all 3 dietary factors. Height and weight and intakes of SSB, FV, and fish were assessed twice by a smartphone-based abbreviated dietary questionnaire completed at 6 months (m) and 18 m follow-up. Main outcome measures were (1) body mass index (BMI) z-score; and (2) an abbreviated Healthy Eating Index (mini-HEI, 1 m window, as mean of z-scores for SSB, FV, and fish). Among the 7,890 randomized adolescents, 5,260 were assigned to any SMS program; 63% (3,338) joined the offered program. Among the 7,890 randomized, 74% (5,853) and 68% (5,370) responded to follow-ups at 6 m and 18 m, respectively. Effects were estimated by intention-to-treat (ITT) analyses and inverse probability weighted per-protocol (IPW-PP) analyses excluding adolescents who did not join the program. Mean (standard deviation (SD)) mini-HEI at baseline, 6 m and 18 m was -0.01 (0.64), 0.01 (0.59), and -0.01 (0.59), respectively. In ITT-analyses, no effects were observed, at any time point, in those who had received any SMS program compared to the non-SMS group, on BMI z-score (6 m: -0.010 [95% confidence interval (CI) -0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI -0.029, 0.033]; p = 0.901) or mini-HEI (6 m: 0.016 [95% CI -0.011, 0.043]; p = 0.253, 18m: -0.016 [95% CI -0.045, 0.013]; p = 0.286). In IPW-PP analyses, at 6 m, a small decrease in BMI z-score (-0.030 [95% CI -0.057, -0.003]; p = 0.032) was observed, whereas no significant effect was observed in mini-HEI (0.027 [95% CI -0.002, 0.056]; p = 0.072), among those who had received any SMS program compared to the non-SMS group. At 18 m, no associations were observed (BMI z-score: -0.006 [95% CI -0.039, 0.027]; p = 0.724, and mini-HEI: -0.005 [95% CI -0.036, 0.026]; p = 0.755). The main limitations of the study were that DNBC participants, though derived from the general population, tend to have higher socioeconomic status than average, and that outcome measures were self-reported.

Conclusions: In this study, a chatbot health education program delivered through an SMS program had no effect on dietary habits or weight trajectories in ITT analyses. However, IPW-PP-analyses, based on those 63% who had joined the offered SMS program, suggested modest improvements in weight development at 6 m, which had faded at 18 m. Future research should focus on developing gender-specific messaging programs including "booster" messages to obtain sustained engagement.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT02809196 https://clinicaltrials.gov/study/NCT02809196.

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短信聊天机器人数字教育计划,旨在提高青少年的健康饮食行为:在丹麦全国出生队列的 7890 名参与者中开展的多因素随机对照试验。
背景:目前还没有发现什么具有成本效益的策略能使人们的饮食习惯向更健康的方向转变。我们研究了参与通过短信服务("SMS-program")发送的聊天机器人健康教育计划是否能改善青少年的饮食行为和体重轨迹。我们还探讨了母亲或同伴参与可能带来的额外效果:我们在丹麦国家出生队列(DNBC)的青少年中开展了一项随机对照试验(RCT)。符合条件的青少年在 2015 年至 2016 年期间,14 岁时填写了一份评估身高、体重和饮食习惯的问卷。三分之二的青少年被邀请参加短信计划,而三分之一("非短信组")的青少年则没有收到邀请。短信计划旨在改善三种主要的饮食摄入行为:含糖饮料(SSB)、水果和蔬菜(FV)以及鱼类。所提供的计划有 3 个因素随机方案;其目的是测试让母亲或朋友也参与健康促进计划的效果,以及测试为期 4 周的个人定制短信计划与针对所有 3 种膳食因素的 12 周短信计划的效果。在6个月和18个月的随访期间,通过基于智能手机的简短膳食调查问卷对身高、体重以及固态碳水化合物、固态脂肪和鱼类的摄入量进行了两次评估。主要结果测量指标为:(1)体重指数(BMI)Z 值;(2)简略健康饮食指数(mini-HEI,1 m 窗口,作为 SSB、FV 和鱼类 z 值的平均值)。在随机抽取的 7890 名青少年中,有 5260 人被分配到任何 SMS 计划中;63%(3338 人)参加了所提供的计划。在随机分配的 7890 名青少年中,分别有 74% (5853 人)和 68% (5370 人)接受了 6 个月和 18 个月的随访。通过意向治疗(ITT)分析和反向概率加权协议(IPW-PP)分析估算了效果,但不包括未参加计划的青少年。基线、6 米和 18 米时的迷你 HEI 平均值(标准差 (SD))分别为 -0.01 (0.64)、0.01 (0.59) 和 -0.01 (0.59)。在 ITT 分析中,与未接受短信服务的人群相比,接受过任何短信服务的人群在任何时间点均未观察到对体重指数 z 值的影响(6 m:-0.010 [95% 置信区间 (CI) -0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI -0.029, 0.033]; p = 0.901)或迷你 HEI(6 m: 0.016 [95% CI -0.011, 0.043]; p = 0.253, 18 m: -0.016 [95% CI -0.045, 0.013]; p = 0.286)。在 IPW-PP 分析中,在 6 m 时,观察到接受过任何 SMS 计划的人群与未接受过任何 SMS 计划的人群相比,体重指数 z 值略有下降(-0.030 [95% CI -0.057, -0.003];p = 0.032),而在迷你 HEI(0.027 [95% CI -0.002, 0.056];p = 0.072)方面未观察到显著影响。在 18 米处,未观察到任何关联(体重指数 z 值:-0.006 [95% CI -0.039, 0.027];p = 0.724;迷你 HEI:-0.005 [95% CI -0.036, 0.026];p = 0.755)。研究的主要局限性在于,DNBC 参与者虽然来自普通人群,但其社会经济地位往往高于平均水平,而且结果测量是自我报告的:在这项研究中,通过短信程序提供的聊天机器人健康教育计划在 ITT 分析中对饮食习惯或体重轨迹没有影响。未来的研究应侧重于开发针对不同性别的信息计划,包括 "助推 "信息,以获得持续的参与:临床试验注册:ClinicalTrials.gov Identifier:NCT02809196 https://clinicaltrials.gov/study/NCT02809196。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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