Twelve Month Efficacy of Computer-Tailored Communication in Boosting Fruit and Vegetable Consumption Among Adults Aged ≥40: A Three Level Meta-Analysis and Systematic Review of Randomized Controlled Trials

Computer tailored health communication (CTC) can enhance fruit and vegetable intake and consequently health by providing personalized feedback. However, few studies have examined the long-term effects of such interventions in middle-aged and older adults. The goal of this research was to assess the 12-month efficacy of CTC in promoting fruit and/or vegetable consumption and potentially identify who among middle-aged and older adults changed their diet after the intervention. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on 2021-12-09, code: CRD42022330491. The research was performed without external funding. We searched six databases (MEDLINE via PubMed, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and PsycINFO) for randomized controlled trials (RCTs) comparing CTC interventions for increasing fruit and/or vegetable intake with usual care/no intervention control in adults aged ≥40, measured 12 months after the pre-test. The search covered the period from January 1, 1990, to January 1, 2022. We selected 16 RCTs with 25,496 baseline participants for the review (SLR), and 11 RCTs with 19 measurements for the meta-analysis (MA). We assessed the risk-of-bias with the JBI Critical Appraisal Checklist. The SLR revealed that at one-year post-CTC intervention, most of the treatment groups increased fruit and/or vegetable intake more than the control groups. The overall bias in the data set was not high. The MA model on 11 RCTs revealed a significant effect size for fruit and/or vegetable consumption in intervention groups compared to control, SMD= 0.21 (CI:0.12-0.30), p=0.0004. The evidence suggests that CTC is a suitable strategy for public interventions aiming to increase fruit and/or vegetable intake in adults aged ≥40. The design of CTC for public interventions should consider the process of change, and stages of change addressing awareness, attitudes, self-efficacy, and social influence as promising concepts for influencing behavior change. STATEMENT OF SIGNIFICANCE: This study is the first to provide a comprehensive and robust synthesis of the long-term efficacy of computer-tailored communication (CTC) interventions for increasing F&V intake in adults aged 40 years or older. Our findings have important implications for public health policy and practice, as they suggest that CTC is a feasible (because of its relatively low-cost, minimal risk, and implementability) and efficacious way to promote 12-month sustained improvements in healthy eating habits in this population group.