This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.
Despite social marketing campaigns and behavior change interventions, young adults remain among the lowest consumers of vegetables. The digital era offers potential new avenues for both social marketing and individually tailored programs, through texting, web, and mobile applications. The effectiveness and generalizability of such programs have not been well documented.
The aim of this systematic review is to evaluate the efficacy and external validity of social marketing, electronic, and mobile phone-based (mHealth) interventions aimed at increasing vegetable intake in young adults.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol will be used to conduct this systematic review. The search strategy will be executed across eleven electronic databases using combinations of the following search terms: “online intervention”, “computer-assisted therapy”, “internet”, “website”, “cell phones”, “cyber”, “telemedicine”, “email”, “social marketing”, “social media”, “mass media”, “young adult”, and “fruit and vegetables”. The reference lists of included studies will also be searched for additional citations. Titles and abstracts will be screened against inclusion criteria and full texts of potentially eligible papers will be assessed by two independent reviewers. Data from eligible papers will be extracted. Quality and risk of bias will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and The Cochrane Collaboration Risk of Bias assessment tool respectively. The external validity of the studies will be determined based on components such as reach, adoption, and representativeness of participants; intervention implementation and adaption; and program maintenance and institutionalization. Results will be reported quantitatively and qualitatively.
Our research is in progress. A draft of the systematic review is currently being produced for publication by the end of 2015.
The review findings will assist the design and implementation of future eHealth and mHealth programs aimed at improving vegetable consumption in young adults.
PROSPERO International Prospective Register of Systematic Reviews: CRD42015017763; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015017763#.VVKtqfmqqko (Archived by WebCite at http://www.webcitation.org/6YU2UYrTn).
Despite national and global social marketing campaigns and behavior change interventions, the current population’s intake of vegetables remains low [
The rise of the digital era offers potential new avenues for both social marketing and individually tailored programs, through texting, web and mobile apps to deliver health messages and facilitate change. Research indicates that electronic (eHealth) and mobile phone (mHealth)-based strategies are a promising channel for the delivery of interventions aimed at promoting healthful behaviors [
When assessing the efficacy of interventions, the degree to which they effectively incorporate behavior change theories should be considered. A review of recent eHealth and mHealth interventions revealed that interventions which included more behavior change techniques had larger effects compared to those that used fewer techniques [
Assessment of the external validity of studies is as equally important as determining efficacy. The external validity of studies has implications on the translation of interventions to the broader young adult population. With the young adult population neglected from many population-wide fruit and vegetable campaigns, investigation of the potential upscaling of current interventions is necessary.
To our knowledge, there is no published review to date focusing on the efficacy and generalizability of social marketing and eHealth and mHealth interventions on vegetable intake in young adults. This review addresses this gap in the literature.
Thus the aims are to: (1) systematically examine the effectiveness of social marketing, electronic and/or mobile phone-based interventions in increasing fruit and vegetable intake in young adults; (2) assess the efficacy/validity of tools used to monitor changes in fruit and vegetable intake; and (3) review the adequacy of reporting of external validity components.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol will be used to conduct this systematic review [
The following electronic databases will be searched for papers published between January 1990 and March 2015: the Cochrane Library, Cochrane Library of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Medline, Embase, PubMed, PyschINFO, Scopus, Web of Science, and Science Direct. The start of 1990 was selected, as it corresponded with the period during which the use of email became widespread [
The eligibility criteria for studies have been selected based on participants, interventions, comparisons, outcomes, and study designs (PICOS). Only studies written in English and published after 1990 will be included.
The target age group for the included studies will be young adults aged 18-35 years inclusive. The participants should be healthy, with no disease or illness which would impact the primary outcome or ability to modify fruit and vegetable intake. There will be no limitation based on gender, ethnicity or socioeconomic status. Interventions set outside of universities will also be included in the review.
The type of interventions that will be considered in the initial search will be eHealth or mHealth-based interventions. These are studies that employ the use of mobile phone apps, texting, email, phone calls, and websites to deliver the intervention. The secondary search will not be limited to eHealth or mHealth interventions and will include social marketing and mass media interventions. These are defined as studies that employ the use of media advertising through television, radio, billboards, and/or social media platforms as well as other community-based activities such as group education and cooking classes to increase fruit and vegetable intake.
Comparisons will be made between baseline and follow up results within and between studies. The differences between intervention and control arms (no intervention or minimal contact) will also be explored.
The primary outcome that will be investigated is the change in fruit and vegetable intake between baseline and follow-up. This can be reported in serves, frequency or grams. Fruit will be included as an outcome to account for studies reporting fruit and vegetable intake concurrently.
The first search will be limited to randomized controlled trials (RCTs) or cluster-RCTs with an aim of increasing fruit and vegetable intake in young adults. The social marketing search will not be limited by study design.
Titles and abstracts of all retrieved studies will be exported to Endnote X6 citation management software (Thomson Reuters, Philadelphia, PA, USA). Duplicates will be deleted before titles and abstracts are reviewed to group papers into either of the following: (1) meeting selection criteria; (2) requiring further examination; or (3) excluded. Papers determined as potentially relevant to the review will be downloaded as full text and reviewed for eligibility by two evaluators (MMN, JC) and further categorized (
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram.
A data extraction table will be designed using principles of the PRISMA statement for reporting systematic review [
An appropriate method of reporting the treatment effect will be determined based on the type of data extracted from included studies. It is anticipated that the mean differences in fruit and vegetable intake between baseline and follow up will be reported. These results will be tabulated to enable qualitative description of results and heterogeneity assessment for potential pooling of results using meta-analysis.
Using the Cochrane Collaboration's tool [
The quality of each study will be determined by two independent parties using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies [
A table collating the reported external validity components of the included studies was designed based on the criteria for rating external validity developed by Green and colleagues [
Our research is in progress. A draft of the systematic review is currently underway and will be submitted before the end of 2015.
This review will present a summary of the efficacy and external validity of the published studies that have used eHealth and mHealth or social marketing strategies to engage young adults in improving their vegetable intake. The findings will provide a scope for the development of future interventions and social marketing campaigns targeted at this age group.
MEDLINE Search Strategy.
Effective Public Health Practice Project
Medline thesaurus Medical Subject Headings
participants, interventions, comparisons, outcomes and study designs
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
The authors thank the School of Molecular Bioscience Librarian Rod Dyson for his assistance with setting up the database search strategy. MMN and JC are PhD students, funded by the Australian Postgraduate Award scholarship.
MMN, JC and MAF developed the research question and MMN drafted the review protocol. All authors have read the final protocol and will contribute to screening, extraction, analysis, and writing of the review manuscript.
None declared.