Tools- of Changes

Community-Based Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity

The Community Preventive Services Task Force (CPSTF) recommends digital health and telephone interventions that are implemented in community settings and focus on improving healthy eating and physical activity among adults interested in improving these behaviors. Sufficient evidence of effectiveness shows the effectiveness of these interventions. The evidence also indicates associated small reductions in weight-related outcomes and clinical outcomes (i.e., diastolic blood pressure, triglycerides, total cholesterol, and low-density lipoproteins). CPSTF also recommends digital health and telephone interventions to increase healthy eating and physical activity among receptive adults in worksite and higher education settings. This report summarizes the effect sizes for 11 outcomes classified as physical activity, dietary, weight-related, and clinical outcomes from a review of 31 studies.

Poor diet and inadequate physical activity are well established risk behaviors for obesity, cardiovascular disease, cancer, and diabetes mellitus. These risk behaviors often cluster, which creates an opportunity to intervene on multiple risk behaviors simultaneously. Over the past decade, the use of digital devices such as computers, smartphones, and tablets to foster or support behavior change has steadily increased.

These Interventions may be delivered in community settings through websites, mobile apps, text messages, emails, or one-on-one telephone calls. They may include one or more of the following:

• Coaching or counseling with trained professionals who provide personalized assistance related to eating and physical activity behaviors, or weight
• Self-monitoring to record eating or physical activity behaviors, or weight
• Goal setting related to eating or physical activity behaviors, or weight
• Social support from peers through social media, internet forums, or discussion groups
• Educational tools and resources designed to support healthy eating or physical activity (e.g., newsletter, handbook)
• Motivational strategies that include incentives, rewards, prompts, and gaming techniques
• Computer-generated feedback that provides tailored information based on performance (i.e., prompts, meeting goals, and adherence

Other key findings inlude the following.

• Interventions that use technology are a convenient way to reach individuals. They have the potential for broad dissemination and scalability (Carter et al., 2013; Roess, 2017; Svetkey et al., 2015).
• Digital health interventions may increase access for people who live in rural areas or have transportation challenges that make it difficult to attend in-person classes or programs.
• The digital divide needs to be considered when using technology other than telephones to implement programs. Key issues include participants' access to affordable internet networks or mobile devices and digital readiness
• Implementers may want to consider the built environment around participants. It is important for participants to have access to healthier foods and safe places where they can be physically active.