Digital Technology in Nutrition Education and Behavior Change: Opportunities and Challenges.

The incorporation of digital technology (digitech) within nutrition education and behavior change interventions (NEBI) has markedly increased, and COVID-19 rapidly accelerated advancement and acceptability in this area.1Hlatshwako TG Shah SJ Kosana P et al.Online health survey research during COVID-19.Lancet Digit Health. 2021; 3: e76-e77Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar The proliferation of digitech, including devices and platforms, creates novel ways for end-users to engage with NEBI and presents unique opportunities for increasing reach and engagement of underrepresented populations.2Rodriguez Rocha NP Kim H eHealth interventions for fruit and vegetable intake: a meta-analysis of effectiveness.Health Educ Behav. 2019; 46: 947-959Crossref PubMed Scopus (18) Google Scholar, 3McGuirt JT Cooke NK Burgermaster M et al.Extended reality technologies in nutrition education and behavior: comprehensive scoping review and future directions.Nutrients. 2020; 12: 1-14Crossref Scopus (13) Google Scholar, 4Vandelanotte C Muller AM Short CE et al.Report past, present, and future of eHealth and mHealth research to improve physical activity and dietary behaviors.J Nutr Educ Behav. 2016; 48: 219-228Abstract Full Text Full Text PDF PubMed Scopus (246) Google Scholar, 5Lane Bakırcı-Taylor A Reed DB Mccool B Dawson JA mHealth improved fruit and vegetable accessibility and intake in young children.J Nutr Educ Behav. 2019; 51: 556-566Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar While a “digital divide” exists with some digitech, like desktop/laptop ownership and home broadband internet access, most people own smart phones (≥ 76%) or use social media (≥ 65%), regardless ofincome, race and ethnicity, or age.6Pew Research Center. Demographics of social media users and adoption in the United States. Pew Research Center. https://www.pewresearch.org/internet/fact-sheet/social-media/#panel-81867c91-92ad-45b8-a964-a2a894f873ef. Accessed April 11, 2023.Google Scholar, 7Vogels, EA. Digital divide persists even as Americans with lower incomes make gains in tech adoption. Pew Research Center. https://pewresearch-org-preprod.go-vip.co/fact-tank/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption/. Accessed April 11, 2023.Google Scholar, 8Atske S, Perrin A. Hoe broadband adoption, compuer ownership vary by race, ethnicity in the U.S. Pew Research Center. https://pewresearch-org-preprod.go-vip.co/fact-tank/ 2021/07/16/home-broadband-adoption-computer-ownership-vary-by-race-ethnicity-in-the-u-s/. Accessed April 11, 2023.Google Scholar Furthermore, digitech can resolve common barriers to NEBI participation (e.g., lack of transportation or time) and can increase NEBI scalability.9Garcia-Huidobro D Allen M Rosas-Lee M et al.Understanding attendance in a community-based parenting intervention for immigrant Latino families.Health Promot Pract. 2016; 17: 57-69Crossref PubMed Scopus (19) Google Scholar Prior to developing or adapting NEBI that incorporate digitech, it is important to consider challenges that might impact their effectiveness and approaches that enhance equitable access. Digitech-specific, evidence-based frameworks are critical for developing effective NEBI. In user-centered design, for example, end users’ needs and preferences are prioritized and used to guide design processes,10Kinzie MB Cohn WF Julian MF Knaus WA. A user-centered model for web site design: needs assessment, user interface design, and rapid prototyping.J Am Med Inform Assoc. 2002; 9: 320-330Crossref PubMed Scopus (103) Google Scholar leading to improved participant engagement and an increased likelihood of an effective intervention.11McCurdie T Taneva S Casselman M et al.mHealth consumer apps: the case for user-centered design.Biomed Instrum Technol. 2012; Fall: 49-56Crossref Scopus (296) Google Scholar Researchers may also consider implementation process models to guide development and optimize sustained digitech utilization. For example, the Exploration, Adoption/Preparation, Implementation, Sustainment (EPIS) model helps identify whether NEBI-related digitech is feasible, adoptable, and relevant to the intended population.12Aarons GA Hurlburt M Horwitz SMC. Advancing a conceptual model of evidence-based practice implementation in public service sectors.Adm Policy Ment Health Ment Health Serv Res. 2011; 38: 4-23Crossref PubMed Scopus (1589) Google Scholar Classic theories, like diffusion of innovation, can also be applied to understand how digitech innovations are adopted. Also, engagement strategies like reminders, coaching, and personalized information13Gan DZQ McGillivray L Larsen ME Christensen H Torok M. Technology-supported strategies for promoting user engagement with digital mental health interventions: a systematic review.Digit Health. 2022; 8PubMed Google Scholar are important considerations in NEBI digitech. Digital inequities, such as inconsistent internet access or low digital literacy, disproportionately burden the same populations burdened by diet-related disease inequities. Employing user-centered design and leveraging digitech already adopted by the intended audience (e.g., among Hispanics, 80% use social media and 85% own smartphones)6Pew Research Center. Demographics of social media users and adoption in the United States. Pew Research Center. https://www.pewresearch.org/internet/fact-sheet/social-media/#panel-81867c91-92ad-45b8-a964-a2a894f873ef. Accessed April 11, 2023.Google Scholar,8Atske S, Perrin A. Hoe broadband adoption, compuer ownership vary by race, ethnicity in the U.S. Pew Research Center. https://pewresearch-org-preprod.go-vip.co/fact-tank/ 2021/07/16/home-broadband-adoption-computer-ownership-vary-by-race-ethnicity-in-the-u-s/. Accessed April 11, 2023.Google Scholar could help reach populations most at risk of diet-related diseases. Another key challenge is the financial cost of developing and maintaining digitech. For example, a mobile application with simple features can cost $16,000 to $32,000, not including maintenance and updates.14Dogtiev A. App Development Cost (2023). Business of Apps. https://www.businessofapps.com/app-developers/research/app-development-cost/. Accessed April 11, 2023.Google Scholar This is coupled with the competition, money, and fast pace of digitech in industry that is often misaligned with the scrutinous, slow pace of research. Rigorous digitech-focused funding mechanisms could help support the development and maintenance of innovations. However, continued funding for maintenance and updates may require further testing or expansion of digitech, as part of additional research proposals. Another strategy is leveraging industry's financial assets and audience reach through collaborative projects that navigate and consider the often-divergent interests of research and industry. Ultimately, digitech holds great promise for enhancing NEBI reach and effectiveness, especially to address disparities, and warrants continued investigation by nutrition educators and researchers. The Society for Nutrition Education and Behavior (SNEB) DigiTech Division is well-positioned to lead this charge through educating and connecting SNEB members with NEBI digitech experts and resources.15Burgermaster M Wong SS Bateson W et al.DigiTech Division: positioning SNEB to lead the way in digital technology for nutrition education and behavior change.J Nutr Educ Behav. 2019; 51: 265-266Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Digitech NEBI can effectively meet the specific needs and preferences of the intended audience, while achieving desired outcomes in nutrition education and behavior change.DuffyView Large Image Figure ViewerDownload Hi-res image Download (PPT)EnahoraView Large Image Figure ViewerDownload Hi-res image Download (PPT)GithinjiView Large Image Figure ViewerDownload Hi-res image Download (PPT)McGuirtView Large Image Figure ViewerDownload Hi-res image Download (PPT)TripicchioView Large Image Figure ViewerDownload Hi-res image Download (PPT)