Co-design of a digital dietary intervention for adults at risk of type 2 diabetes.

BACKGROUND: Co-design has the potential to create interventions that lead to sustainable health behaviour change. Evidence suggests application of co-design in various health domains has been growing; however, few public-facing digital interventions have been co-designed to specifically address the needs of adults at risk of Type 2 diabetes (T2D). This study aims to: (1) co-design, with key stakeholders, a digital dietary intervention to promote health behaviour change among adults at risk of T2D, and (2) evaluate the co-design process involved in developing the intervention prototype. METHODS: The co-design study was based on a partnership between nutrition researchers and designers experienced in co-design for health. Potential end-users (patients and health professionals) were recruited from an earlier stage of the study. Three online workshops were conducted to develop and review prototypes of an app for people at risk of T2D. Themes were inductively defined and aligned with persuasive design (PD) principles used to inform ideal app features and characteristics. RESULTS: Participants were predominantly female (range 58-100%), aged 38 to 63 years (median age = 59 years), consisting of a total of 20 end-users and four experts. Participants expressed the need for information from credible sources and to provide effective strategies to overcome social and environmental influences on eating behaviours. Preferred app features included tailoring to the individual's unique characteristics, ability to track and monitor dietary behaviour, and tools to facilitate controlled social connectivity. Relevant persuasive design principles included social support, reduction (reducing effort needed to reach target behaviour), tunnelling (guiding users through a process that leads to target behaviour), praise, rewards, and self-monitoring. The most preferred prototype was the Choices concept, which focusses on the users' journey of health behaviour change and recognises progress, successes, and failures in a supportive and encouraging manner. The workshops were rated successful, and feedback was positive. CONCLUSIONS: The study's co-design methods were successful in developing a functionally appealing and relevant digital health promotion intervention. Continuous engagement with stakeholders such as designers and end-users is needed to further develop a working prototype for testing.

Effect of Experiential Vegetable Education Program on Mediating Factors of Vegetable Consumption in Australian Primary School Students: A Cluster-Randomized Controlled Trial.

Schools provide a relevant and equitable environment to influence students towards increased vegetable consumption. This study aimed to evaluate the effectiveness of a Vegetable Education Resource To Increase Children's Acceptance and Liking (VERTICAL) for Australian primary schools (curriculum aligned and based on a framework of food preference development and sensory experiential learning) on positively influencing factors predisposing children towards increased vegetable consumption. The secondary aim was to evaluate two levels of teacher training intensity on intervention effectiveness. A cluster-RCT amongst schools with three conditions was conducted: 1 = teaching VERTICAL preceded by online teacher training; 2 = as per 1 with additional face-to-face teacher training; 3 = Control. Pre-test, post-test and 3-month follow-up measures (knowledge, verbalization ability, vegetable acceptance, behavioural intentions, willing to taste, new vegetables consumed) were collected from students (n = 1639 from 25 schools in Sydney/Adelaide, Australia). Data were analyzed using mixed model analysis. No difference in intervention effectiveness was found between the two training methods. Compared to the Control, VERTICAL positively affected all outcome measures after intervention (p < 0.01) with knowledge sustained at 3-month follow-up (p < 0.001). In conclusion, VERTICAL was effective in achieving change amongst students in mediating factors known to be positively associated with vegetable consumption.

Acceptance of health-promoting Brassica vegetables: the influence of taste perception, information and attitudes.

OBJECTIVE: To investigate the relative importance of specific health knowledge and taste on acceptance of Brassica vegetables (broccoli, red and green cabbages, broccolini, cauliflower, Brussels sprouts). DESIGN: In a sample of adults all reporting medium-high physical activity (as a marker/control of health behaviour) and reporting either low (≤2 portions/d) or high (≥3 portions/d) vegetable intake, half of those with low vegetable consumption (Li group) and half of those with high vegetable consumption (Hi group) received cancer protection information, while the other half did not (Ln and Hn groups), before hedonic (9-point), perceived taste and flavour impact responses (100 mm scales) to samples of six Brassica vegetables were elicited. Additionally, attitudes towards foods for health, pleasure and reward, sociodemographics, intentions to consume the vegetables in the near future and recall of health information were also measured. SUBJECTS: Adult males and females (n 200) aged 18-55 years. SETTING: Central location testing, Adelaide, Australia. RESULTS: Information groups Li and Hi reported specific cancer protection information knowledge, in contrast to Ln and Hn groups (P < 0·000). Information independently influenced responses to (the least liked) Brussels sprouts only. Multivariate regression analysis found sensory perception tended to predict liking and intentions to consume Brassica vegetables. For example, broccoli hedonics (adjusted R 2 = 0·37) were predicted (P < 0·05) by bitterness (ß = -0·38), flavour (ß = 0·31), sweetness (ß = 0·17) and female gender (ß = 0·19) and intentions to consume (adjusted R 2 = 0·20) were predicted (P < 0·05) by bitterness (ß = -0·38), flavour (ß = 0·24), female gender (ß = 0·20) and vegetable intake (ß = 0·14). CONCLUSIONS: Addressing taste dimensions (while retaining healthy compounds) may be more important than promoting health information in order to increase the popularity of Brassica vegetables.

Food neophobia and associations with cultural diversity and socio-economic status amongst rural and urban Australian adolescents.

Exposure to diverse cultures and higher socio-economic status (SES) may increase knowledge of a wide variety of stimuli, including food, and be negatively associated with food neophobia. We contrasted questionnaire responses from two groups of Australian high school students (aged 12-18 years) from remote rural (rural, n=243) and cosmopolitan urban (city, n=696) locations to the food neophobia scale (FNS), familiarity with certain foods and willingness to try those foods. Cultural diversity measures and two SES scales were created. City students were less food neophobic than rural students (mean FNS scores 29.35 versus 34.68, p<0.001). City students were also significantly more familiar with different foods and more willing to try unfamiliar foods, were of higher SES and had greater exposure to cultural diversity. However, the association between the FNS and familiarity with foods, willingness to try unfamiliar foods, SES, and exposure to cultural diversity, were only weak or moderate for both city and rural students. Greater exposure to cultural diversity and higher SES has some influence on adolescents' responses to unfamiliar foods, but the relationship between these factors and the FNS score is tenuous.