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Harris J, Felix L, Miners A, et al. Adaptive E-Learning to Improve Dietary Behaviour: A Systematic Review and Cost-Effectiveness Analysis. Southampton (UK): NIHR Evaluation, Trials and Studies Coordinating Centre (UK); 2011 Oct. (Health Technology Assessment, No. 15.37.)



Despite the availability of several good trials of e-learning interventions for dietary behaviour change, the evidence for effectiveness on dietary behaviours is weak. Although the pooled effects of interventions showed no effects of public health importance, there was high and unexplained heterogeneity in many trial results.

Neither the design nor the targeting of e-learning interventions can yet be informed by available evidence; the implication of these conclusions for policy and practice is that such interventions should not be introduced into routine practice at present. E-learning for dietary behaviour change may, however, have potential as one approach within wider intervention programmes to tackle poor diet and obesity in the population.


While the published evidence base was limited, the results from the modelling exercise suggest that e-learning devices to promote dietary behaviour change are unlikely to be cost-effective at conventional UK cost per additional QALY thresholds, unless they are much less costly to provide than assumed in the analysis, particularly the initial (fixed) setup costs. The current clinical and economic evidence base suggests that e-learning devices designed to promote dietary behaviour change will not produce clinically significant changes in dietary behaviour, and are at least as expensive as other individual behaviour change interventions.

Recommendations for future research

We identified 43 trials of e-learning for dietary behaviour change, and there are many more studies trialling e-learning interventions for altering different health behaviours. Despite the relatively high EVPI results from the cost-effectiveness modelling, we believe the implication for research is that further clinical trials of individual e-learning interventions should not be undertaken until theoretically informed work, which addresses the question of which characteristics of the target population, target behaviour, content and delivery of the intervention are likely to lead to positive results, is completed. This work would include:

  • reviews of available behaviour change theoretical frameworks and the empirical data to support each approach
  • research in behaviour change techniques (linking theory to techniques) to provide empirical data to help understand which techniques are effective, and under which conditions
  • cohort and other study designs which actively map and explore the pathways of change in outcomes among users of the intervention.
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Included under terms of UK Non-commercial Government License.

Cover of Adaptive E-Learning to Improve Dietary Behaviour: A Systematic Review and Cost-Effectiveness Analysis
Adaptive E-Learning to Improve Dietary Behaviour: A Systematic Review and Cost-Effectiveness Analysis.
Health Technology Assessment, No. 15.37.
Harris J, Felix L, Miners A, et al.

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