Online programs improve fruit and vegetable consumption

Researchers found that when given access to an online program about fruits and vegetables, participants increased their daily fruit and vegetable intake by more than two servings. Many of the participants continued using the program after the study concluded, and even reported their family members became involved in the program.

"People already know the health benefits of fruits and vegetables, but they often don't know how to incorporate them into their diet," says study senior author Christine Cole Johnson, Ph.D., M.P.H., chair of Henry Ford's Department of Biostatistics and Research Epidemiology. "That's why our study worked. Using online programs, we were able to offer study participants practical and easy tips to increase their daily fruit and vegetable intake."

Results are published in this month's issue of the American Journal of Public Health.

According to the Center for Disease Control and Prevention, fewer than 25 percent of adults in the United States eat five servings of fruit and vegetables per day. Those who eat more fruits and vegetables are likely to have reduced risk of chronic diseases, including stroke and certain cancers.

The 12-month-long Henry Ford study recruited members of Health Alliance Plan and four other HMOs in Seattle, Denver, Minneapolis and Atlanta, ages 21 to 65. Study participants were placed in one of these three groups:

• A control online program that provided general information for the participants about improving their fruit and vegetable intake.
• A program that was similar but personalized to the individual's needs
• A program that incorporated the other two components and was also supplemented with motivational interviewing counseling via e-mail.

The program was divided into four sessions. Each session included four to five pages of core content, illustrations and optional links to more detailed information and special features designed to supplement session content. For example, special features illustrated serving sizes and nutritional similarities of fresh versus frozen versus canned foods. Another optional feature presented 300 fruit and vegetable-based recipes. Short video and audio files were offered to reinforce text on behavioral strategies. Once available, all program components were accessible throughout the 12-month study period.

An optional feature offered menus individually tailored by nutrition experts and were generated on the basis of participants' fruit and vegetable preferences and dietary restrictions.

At the end of the study, researchers found that there was improvement across all study groups, but the most significant changes were with the group that had motivational interviewing and counseling.

"We found that giving participants gentle reminders that refocused them on their goals greatly improved progress," says study co-author, Gwen Alexander, PhD, assistant research scientist. "They were being held accountable for their progress, which became a key motivator."

Up next: Drs. Johnson and Alexander are now working on creating a similar study focused on people ages 21 to 30, to find new strategies to help them incorporate more fruits and vegetables into their diet, while catering to their lifestyle.