Influence of Behavioral Theory on Fruit and Vegetable Intervention Effectiveness Among Children: A Meta-Analysis

• Published in: Journal of nutrition education and behavior 2014-11, Vol.46 (6), p.506-546
• Main Authors: Diep, Cassandra S., PhD, Chen, Tzu-An, PhD, Davies, Vanessa F., MSc, Baranowski, Janice C., MPH, RD, Baranowski, Tom, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Behavior; Adolescent Nutritional Physiological Phenomena; Behavior Control; Behavior Therapy; Child; Child Behavior; Child Nutritional Physiological Phenomena; Child, Preschool; children; Children & youth; Diet; dietary change; Effect Size; Fruit; Gastroenterology and Hepatology; Humans; Internal Medicine; Intervention; Literature Reviews; Meta Analysis; Nutrition; Nutrition Policy; Patient Compliance; Regression analysis; Systematic review; theory; Vegetables
• ISSN: 1499-4046; 1878-2620; 1708-8259
• DOI: 10.1016/j.jneb.2014.05.012

Abstract Objective To test the hypotheses that interventions clearly based on theory, multiple theories, or a formal intervention planning process will be more effective in changing fruit and vegetable consumption among children than interventions with no behavioral theoretical foundation. Design Systematic review and meta-analysis. Setting Identification of articles in PubMed, PsycInfo, Medline, Cochrane Collaborative database, and existing literature reviews and meta-analyses. Participants Children aged 2–18 years. Interventions Change in fruit and/or vegetable consumption in dietary change interventions. Methods Meta-analysis, meta-regression analysis, and summary reporting for articles. Conclusions and Implications Predicating an intervention on behavioral theory had a small to moderate enhancement ( P < .001) of outcome effectiveness. Differences in mean Hedges' g effect sizes between theory and non-theory interventions were 0.232 for fruit, 0.043 for vegetables, and 0.333 for fruit and vegetables combined. There was mixed support, however, for enhanced dietary change with multiple theories or a formal planning process. After controlling for study quality, theory use was related only to vegetable consumption ( β = 0.373; P < .001). More research is needed on theory's influences on dietary behaviors to guide future interventions among children. More research is also needed to identify what may be effective practical- or experience-based procedures that complement theory, to incorporate into interventions.