摘要：Objectives. We assessed change in fruit and vegetable intake in a population-based sample, comparing an online untailored program (arm 1) with a tailored behavioral intervention (arm 2) and with a tailored behavioral intervention plus motivational interviewing–based counseling via e-mail (arm 3). Methods. We conducted a randomized controlled intervention trial, enrolling members aged 21 to 65 years from 5 health plans in Seattle, Washington; Denver, Colorado; Minneapolis, Minnesota; Detroit, Michigan; and Atlanta, Georgia. Participants reported fruit and vegetable intake at baseline and at 3, 6, and 12 months. We assessed mean change in fruit and vegetable servings per day at 12 months after baseline, using a validated self-report fruit and vegetable food frequency questionnaire. Results. Of 2540 trial participants, 80% were followed up at 12 months. Overall baseline mean fruit and vegetable intake was 4.4 servings per day. Average servings increased by more than 2 servings across all study arms ( P < .001), with the greatest increase (+2.8 servings) among participants of arm 3 ( P = .05, compared with control). Overall program satisfaction was high. Conclusions. This online nutritional intervention was well received, convenient, easy to disseminate, and associated with sustained dietary change. Such programs have promise as population-based dietary interventions. Accumulating evidence has linked diet to a number of chronic diseases, prompting calls for innovative dietary interventions aimed at increasing intake of fruits and vegetables. 1 – 3 Fewer than 25% of US adults eat 5 servings of fruits and vegetables per day, as recommended by the National Cancer Institute (NCI) 4 ; far fewer meet current guidelines of 5 to 9 servings per day. 5 , 6 Further, intake is disproportionately lower within some sociodemographic groups, such as African Americans, Hispanics, and those with lower education. 5 , 7 – 9 Reasons for inadequate intake of fruits and vegetables include lack of awareness of recommendations, 10 not recognizing the connection between diet and health, 11 and perceived difficulty of increasing servings. 12 Evidence since the 1990s suggests that computer-tailored interventions can promote healthy eating habits. 13 – 16 The advantages of Internet programs are convenience, relatively low cost of dissemination, and options to incorporate a range of multimedia components (e.g., audio, video) to increase self-paced engagement and appeal to a range of learning styles. Further, content can be individually tailored to personal needs, preferences, and psychological characteristics. Tailored behavior change programs are generally more effective than those with untailored content, in part because they are perceived as more personally relevant and salient. 14 , 16 – 18 Providing supplemental support through counseling, in addition to online didactic intervention, can augment an intervention's effectiveness, 19 especially if counseling includes guided problem-solving and support for participant-generated solutions. This is consistent with the core principles of motivational interviewing, 20 a counseling approach that encourages and supports the client's choices. According to recent meta-analyses, motivational interviewing is effective at promoting change across a range of health behaviors, 21 including fruit and vegetable consumption. 22 , 23 We designed the present study, Making Effective Nutritional Choices (MENU), to compare the efficacy of (1) a tailored, online dietary intervention program to increase fruit and vegetable intake, (2) this same intervention supplemented with motivational interviewing counseling via e-mail, and (3) an untailored online program. To our knowledge, principles of motivational interviewing have never been applied to counseling delivered via e-mail.
