In the last decades, a lot of effort has been put into improving dietary habits through health interventions, however it has not been very effective: in most European countries, actual consumption does not match with basic recommendations for healthy nutrition. Despite some improvements, diets still contain too much saturated fat, sugar and salt and insufficient vegetables, fruits and fish. Dietary habits are important determinants of health since unhealthy eating can lead to for instance obesity, diabetes, cardiovascular and malignant diseases. The growing rate of those nutrition related diseases stresses the need for innovative approaches that effectively influence food behaviour [1-2]. In this article, we will shortly discuss the use of Interactive Computer Technology (ICT) for personalisation of nutrition communication.
Personalisation
As nutritional science slowly makes progress in moving from identifying general nutrition deficiencies towards identifying nutritional needs at the personal level, the popularity of the innovative concept of personalising nutrition communication is increasing. Personalising refers to tailoring communication to an individuals food preferences, -habits and -needs shaped by their physical, social and environmental circumstances. Research has shown that adaptation of information to an individuals situation is more effective in influencing health behavior than general information [3-13]. Looking closer at behavior change models such as the Health Belief Model (HBM), Protection Motivation Theory (PMT) and Theory of Planned Behavior (TPB), the importance of the personal factor for motivating individuals to change their behavior can be further explored [14-16]. These theories all include the individual evaluation of actual and recommended behavior as an influencing factor of motivation for behavior change. Making communication personal can influence this individual evaluation in several ways for instance through:
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Perceived vulnerability: Communication on the risks of unhealthy eating adapted to an individuals lifestyle (e.g. high intake of calories), physical (e.g. family history) and environmental circumstances (e.g. desk-work) can increase perceived personal vulnerability to nutrition-related diseases. High perceived susceptibility is known to influence motivation for behavior change;
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Perceived self-efficacy: Self-efficacy or perceived behavioral control represent an individuals perception of how easy or difficult it is to eat healthy and their perception about whether they are able to do so. Performance history has a large influence on feelings of self-efficacy [17]. By personalizing communication, specific attention can be paid to an individuals feelings of self-efficacy. The communication on what to eat can for instance be matched with an individuals level of cooking skills. Also, success-stories on healthy cooking could be offered to influence performance history.
Personalisation with use of Interactive Computer Technology
In the Netherlands, personalization of nutrition communication used to be the job of dieticians. Nowadays, personalized communication is also provided with the use of Interactive Computer Technology (ICT). Communication channels such as the Internet and mobile phones are used in nutrition interventions, stand-alone and additional to face-to-face contact. In this innovative approach, elements of face-to-face consultation (interaction, personalisation), mass media channels (large reach) and ICT (interaction, processing capacity, user control on place and time) can be combined. The increasing access to Internet [18] and the decrease of costs for computers and high-speed Internet connections fuel the use of ICT to develop nutrition interventions with large reach at relative low costs.
Can personalisation with use of ICT contribute to effectiveness?
The impact of health interventions depends on reach ànd effectiveness [19]. In the review of de Nooijer and colleagues (2005), low exposure to and low use of interventions was mentioned as a possible barrier for effectiveness. Therefore, the potential large reach can be questioned. They also conclude that insufficient evidence is available to draw conclusions on the effectiveness of internet-interventions compared to other interventions. The reviewed articles do not provide enough information on specific effective elements to formulate a conclusion20. In an earlier review on the effects of internet interventions on patient-groups, Kirsch & Lewis (2004) found a significant intervention-effect for improving knowledge, self-efficacy and self-care. Effects on behaviour however were rarely found21. Hardly any research has been done yet on the effect of using other ICT-based communication channels such as mobile phones or other wireless applications in nutrition interventions.
Conclusion and discussion
It can be concluded that the use of ICT applications in nutrition interventions is promising in terms of providing personalised nutrition communication with relative large reach at low costs. But more insight is needed on how to improve exposure and use of the interventions and on whether personalisation with the use of ICT has the same influence on motivation for behaviour change compared to personalisation through face-to-face contact. At the department of Communication Science of Wageningen University, forthcoming research will be focused on how end-users define their own personal eating style and what should be addressed in personalised interventions on healthy eating. The barriers and chances defined by end-users of the use of ICT as a communication channel will receive special attention.
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Note: Laura Bowman is a PhD Scholar and Dr. Maria A Koelen is a faculty in the Department of Communication Sciences, Wageningen University, Wageningen, The Netherlands
Correspondence Address: Wageningen University, Communication Sciences (Bode 79) PO Box 8130, 6700 EW Wageningen.
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