Often, being away from home for the first time, coupled with limited knowledge regarding healthy eating behaviors, leads to poor food choices and an increased risk of obesity among college-aged young adults. These college students are prone to high-calorie diets and limited physical activity, putting them at risk for obesity, a physiologically, psychologically, and financially costly epidemic in the United States. College students use their cellular phones over eight and a half hours a day and cell phones are their primary means of information consumption outside of the classroom, suggesting that the phones would be a useful tool to provide nutrition education to this at-risk population.
This mixed-methods randomized-controlled trial took place over eight weeks, between 9/15/15 and 12/2/15. The primary aims of this study were to assess the effectiveness and feasibility between an educational nutrition intervention delivered via smartphone texts and a traditional in-office setting for 18-22-year-old, overweight college students at the Sonoma State University Student Health Center. Using simple randomization, participants were assigned to one of two groups: text, or in-office.
Participants in the in-office group received one-on-one nutrition counseling framed within the social cognitive theory by a registered nurse at the study onset, week two, and week four. Participants in the text group received the same information, broken up into weekly text messages with links to websites, YouTube, and explanations of content. Participant characteristics, including weight, height, and health behaviors (hours of sleep a night, number of fruits and vegetables per day), were assessed at the study onset (T1) and again at week two (T2), week four (T3), and week eight (T4). All participants were invited to take part in an in-depth, qualitative, face-to-face interview at the end of the study (T4).
Nine participants completed both the trial and interviews. Two-thirds (66.7%, n=6) were in the text group, 66.7% (n=6) were female, 33.3% (n=3) were minorities, 66.7% lived on- campus, and 44.4% (n=4) took part in the university’s on-campus meal plan. No statistically significant differences were noted in participant characteristics, or health behaviors between the two groups throughout the study. Although no statistical significance was noted between the two groups with regard to weight change, the text group’s mean weight decreased from 188.25(sd=25.03) pounds to 184.58(sd=24.67) pounds while the in-office group’s mean weight increased from 254.00(sd=90.15) to 257.00(sd=94.14) pounds. Weight loss in the text group should be further evaluated as it may hold clinical significance for effectiveness of the intervention.
Through qualitative interviews exploring participants’ experiences, four major themes emerged. All participants in the text group (n=6) stated that they felt there was a need for their method of education, they felt their method was effective, they would recommend their method, and their health behaviors changed positively. For the in-office group, all participants (n=3) said there was a need for their method of education, 67% (n=2) said it was effective, all would recommend it, and 67% stated that they changed their behaviors.
Both the quantitative and qualitative findings of this study hold clinical significance as to the effectiveness and feasibility of text messages as a means of providing nutrition education in the college setting. Future research with larger sample sizes and a longer-term study are recommended for more statistical power and to determine the long-term benefits of these methods of nutrition education
