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PLoS One. 2019 Jan 17;14(1):e0209863. doi: 10.1371/journal.pone.0209863. eCollection 2019.

Randomized trial of planning tools to reduce unhealthy snacking: Implications for health literacy.

Author information

1
Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia.
2
Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.

Abstract

OBJECTIVE:

Guidance to address health literacy often focuses on health education rather than tools to facilitate action, despite action being important for self-management. This study evaluated an online intervention informed by health literate design principles and behavior change theory to reduce unhealthy snacking.

METHODS:

440 participants were recruited online and randomized to an intervention: 1) Health-literate action plan (guided implementation intention); 2) Standard action plan (self-guided implementation intention); 3) Education (healthy snacking fact-sheet). The primary outcome was self-reported unhealthy snacking. Follow-up was at 1 month.

RESULTS:

373 participants (84.8%) completed follow-up. Half the sample had adequate health literacy (52%), and the other half had low (24%) or possibly low (25%) health literacy, as measured by Newest Vital Sign (NVS). At follow-up, lower health literacy was associated with more unhealthy snacks and there was no overall difference between intervention groups. However, participants with lower health literacy who used the health-literate action plan reported less unhealthy snacking compared to the standard action plan; the reverse was true for those with higher health literacy scores (b = 1.7, p = 0.03). People scoring 2 points below the mean NVS (M = 3.4, SD = 2.0) using the health-literate action plan reported eating 8 fewer serves of unhealthy snacks, whereas people scoring 2 points above the mean NVS reported eating 6 more serves of unhealthy snacks using the same tool.

CONCLUSIONS:

These findings suggest that the universal precautions approach currently recommended for health information may be less effective for facilitating action than tailoring to health literacy level.

TRIAL REGISTRATION:

ANZCTR identifier: ACTRN12617001194358.

Conflict of interest statement

The authors have declared that no competing interests exist.

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