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Supplementary Table 1 Ovid Medline search strategy to identify brief nutrition interventions in adults

# Searches Results1 Feeding Behavior/ 425372 Eating/ 455803 food intake.mp. 337024 food habits.mp. 253095 nutrition*.mp. 2794256 (diet* adj5 (intake or behavio?r* or quality or pattern* or habit* or guideline*)).mp. 595007 (eat* adj3 (behavio?r* or pattern* or habit*)).mp. 122938 (fruit* or vegetable* or fat or fiber or fibre or sugar or "energy-dense food*" or

"sometimes food*" or "discretionary food*" or "core-food*" or "non-core food*").mp.374595

9 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 72809310

Randomized Controlled Trial/ 413818

11

Controlled Clinical Trial/ 90563

12

random*.tw. 732137

13

trial.tw. 380525

14

Clinical Trial/ 499175

15

pseudo.tw. 30046

16

quasi experimental.tw. 6069

17

10 or 11 or 12 or 13 or 14 or 15 or 16 1298112

18

education.mp. 586304

19

program*.mp. 691880

20

intervention*.mp. 615102

21

18 or 19 or 20 1642807

22

(brief or minimal or "single dose" or "single contact" or "single session" or "one-time" or "one dose" or "one contact" or "one session" or screening or feedback or immediately).mp.

1019608

23

9 and 17 and 21 and 22 1891

24

limit 23 to (english language and humans and "all adult (19 plus years)") 1210

Explanation of search terms: - The forward slash symbol (/) means that the term is a valid controlled vocabulary term which

has been searched in the Subject Headings field of the database.- ‘Mp’ searches several fields at once: MP search looks in the Title, Original Title, Abstract,

Subject Heading, Name of Substance, and Registry Word fields- .’tw.’ indicates a search for a term in title/abstract- ‘adj5’ searches for both terms within five words of each other in either order. ‘adj3’ searches

for both terms within three words of each other in either order.

1

Supplementary Table 2 Detailed summary of study characteristics

Study,Country

Participants

Intervention Results

Na, mean age, % female, setting

Intervention description Comparator description

Delivery mode

Study arms

Follow upc

BCTs Nutrition outcomes/measure

Summary of findings

Armitage 2001,1 UK

51737.0 years81.4%Workplace

1. Feedback group received a package including nutrition education leaflet (e.g. types of fat, recommendations, relationship with disease) and feedback on % energy from fat in their diet.

2. The no feedback group received the same nutrition education leaflet, but not the feedback.

Print materials: intervention materials mailed to participants

2 5 months

Feedback group – 2.2, 5.1, 6.2 No feedback group – 5.1

Total & saturated fat intake. FFQ.

Feedback group decreased total fat (-5.62 grams/day (p<0.001)), and saturated fat (-2.28 grams/day (p<0.001)), and increased % energy from fat (+0.34 (p=0.32)). No feedback group changes were -0.13 grams/day (p=0.91), -0.43 grams/day (p=0.47), and +0.48% (p=0.017) respectively. Between group differences significant for total (p<0.01) & saturated fat (p<0.05), but not % fat intake (p=0.74).

Armitage 2004,2 UK

26433.3 years60%Workplace

Participants were instructed to write detailed plans to eat a low fat diet over the next month, instructions were included at the end of the baseline questionnaire.

No intervention control

Print materials, mailed through the workplace internal mail system.

2 1 month

1.4 Fat intake. FFQ

Intervention group reduced total fat (-3.94grams/day, p<0.01), saturated fat (-1.62grams/ day, p<0.01) and fat intake % (-0.75%, p<0.05) from baseline, and compared with control (p values<0.05). Control group changes non-significant (total fat +0.36grams/day, saturated fat +0.03, fat intake % +0.5).

Armitage 2007,3 UK

8219.5 years80.0%University

Participants instructed to form action plans to eat an extra fruit serve/day over the next 2 weeks.


Print materials: booklets distributed in uni residence

2 2 weeks

1.4, 4.2 Fruit serves/ 2 weeks. Days eating an extra

Intervention group increased fruit intake significantly more than control (F(1,81)=7.33, p<0.01); intervention +2.69 pieces/2 weeks (p<0.05), controls;-1.45 pieces/2 weeks

2

halls. serve (follow up).2 item screener

(p=0.43).

Armitage 2015,4 UK


1. Self-generated implementation intention group read a brief statement encouraging them to plan to consume an extra fruit serve/day, and given instructions to write detailed situation specific plans. 2. Volitional help sheet implementation intention intervention group read the same statement and received the same instructions & given help sheets with examples.

3. No instruction group: read the same brief statement encouraging them to plan to consume an extra fruit serve/day and were provided space to write their plans.

Print materials: sheets attached to baseline survey, distributed through the workplace internal mail system.

3 1 month

Self-generated group – 1.4, 4.2Volitional help sheet group – 1.2, 1.4, 4.2 No instruction group – 1.4, 4.2

Fruit serves/day. FFQ.

Volitional help sheet group increased fruit intake (+0.10 serves/day) significantly more than both the self-generated group (+0.07 serves/day, p=0.02) and the no instruction group (-0.05 serves/day, p=0.002).

Baker 2002,5 UK

742NR52.0%Primary care

Participants received a 2 page tailored (by stage of change) psycho-educational written resource; information on recommendations, feedback on current intake and intention to change and suggestions to overcome barriers.



2 6 weeks

2.2, 4.1, 11.2

Fruit & vegetable serves/day. FFQ.

Intervention group increased intake significantly more than control for fruit (+0.59 serves/day compared with +0.14 serves/day, p <0.001) and vegetables (+0.47 serves/day compared with +0.12 serves/day, p <0.001).

Block 2004,6 US

31950.1 years100.0%Community

1. Intervention participants completed the Little by Little program fruit & veg modules, including diet screening (10 questions on usual intake) &

2. Control participants completed a stress management module in the same format.

Computer program: participants completed using computer

2b 2 months

1.3, 1.9, 2.2, 4.1

Fruit and vegetable serves/day & occurrences/ day.24hr

Intervention group did not increase fruit and veg serves/day compared with control (numbers not reported), however did increase occurrence/day of consuming fruit and veg (+1.2

3

individual feedback, & additional info e.g. eating out, goal setting, suggestions to improve.

s at recruitment sites.

recall. occurrences/day compared with controls +0.7 occurrences/day, p=0.052).

Brinberg 2000,7 US

13319 years56%University

1. Tailored intervention: information on nutrition & health, risks of low fibre, fibre rich foods, fibre recommendations, goal setting, tailored information (fibre content of frequently consumed foods, feedback on intake vs recommended, specific tips to increase intake). 2. General intervention + feedback: information on the role of fibre, recommended intakes, plus feedback on intake.

3. General intervention: information on the role of fibre & recommended intakes4. No intervention control

Interventions were delivered face to face by a nutrition educator, including the use of print materials.

4 6 months

Tailored intervention – 1.1, 1.3, 2.2, 4.1, 4.2, 5.1, 8.2 General intervention with feedback – 2.2, 5.1General intervention – 5.1

Fibre intake (grams/day). FFQ. Fibre knowledge assessed by multiple choice questionnaire (follow up only)

All groups increased fibre intake (tailored +6.3 grams/day, general with feedback +1.58 grams/day, general +0.91 grams/day and control +1.01 grams/day). Post hoc tests showed the tailored group significantly increased fibre compared with all other groups (p<0.01). The tailored group also had significantly greater knowledge scores compared with all other groups.

Brouwer 2015,8 US


1. The education only group were provided with 3 written nutrition education materials to read (focusing on dietary guidelines and tips to meet these). 2. The education + goal planning group received the same education materials, plus were instructed to write nutrition goals and discussed these with the interviewer.

No intervention control (participants were asked a series of non-study related questions to ensure a similar contact time)

Print materials + in person: participants attended a 30-40minute interview

3 4 weeks

Education– 4.1, 5.1, 9.1 Education + Self as doer– 1.3, 4.1, 5.1, 8.1, 8.3, 9.1, 13.4, 13.5, 15.2, 15.4

Healthy food serves/day(fruit, low fat dairy, veg, wholegrains and sugar sweetened drinks).Repeat 4-day food diaries.

Low fat dairy consumption significantly increased in the education + goal planning group compared with the education only group (+0.21 compared with -0.41 cups/day, p=0.03).

Brug 1996,9

34739 years

1. Tailored intervention: received a 4-9 page

2. Non tailored intervention:

Print materials,

2 3 week

Tailored-2.2,

Fat, fruit and

Tailored intervention group significantly reduced fat score

4

Netherlands

17%Workplace

letter consisting of educational material, feedback on intake and specific dietary advice.

received a 5 page letter with educational material and non-specific dietary advice.

mailed to participants

s 4.1, 5.1, 5.2, 5.6, 6.2, 12.3, 13.3Non-tailored-None

vegetable intake. FFQ.

compared with non-tailored (-2.1 compared with -1.2, p<0.01). Changes in fruit and vegetable serves were not significant.

Brug 1998,10 Netherlands

43144 years82%Community

1. Tailored feedback intervention: received a 4-8 page letter consisting of educational material, feedback on intake and specific dietary advice.

2. General nutrition information group: received a 5-page letter with educational material and non-specific dietary advice.

Print materials, mailed to participants

2b 4 weeks & 8 weeks

Tailored-2.2, 4.1, 5.1, 5.2, 6.2, 8.2, 12.2, 12.3, 13.3General-4.1, 5.1, 8.2

Fat, fruit and vegetable intake. FFQ.

Tailored intervention group significantly reduced fat intake at both follow-ups compared with general group (-1.8 fat score at 8-weeks vs -0.7 (p=0.001)) and increased veg intake at 4-weeks (+0.07 vs +0.03 serves/day, p<0.04), however change not sustained at 8-weeks. No changes in fruit intake.

Brug 1999,11 Netherlands

31540 years89%Workplace

1. Diet & psychosocial feedback group: letter with feedback on fat, fruit and veg intake vs recommendations, advice to change based on usual diet, plus psychosocial feedback and suggestions tailored to attitudes, perceived social support and self-efficacy expectations. Low fat recipes were also provided.

2. Diet feedback group: letter with diet feedback, and low fat recipes as per other group but without the psychosocial feedback and suggestions.


2 3-4 weeks

Diet & psych feedback group – 2.2, 4.1, 6.2, 12.2, 12.3, 13.3Diet feedback group – 2.2, 4.1

Fat, fruit and vegetable intake. FFQ.

No between group differences in fat, fruit or vegetable intakes. Significance of within group differences (i.e. change from baseline) were not reported.

Campbell 1994,12 US

45940.8 years75.3%Primary care

1. Tailored intervention: nutrition information packet with a profile summarising current diet and interest in changing behaviour, and one

2. Non-tailored intervention: nutrition information packet with standard

Print materials: intervention materials were

3 4 months

Tailored group – 2.2, 4.1, 5.1, 6.2, 7.1Non-

Fat, fruit and vegetable intakes. FFQ.

The tailored intervention compared with control group significantly reduced total fat (-10.3 and -1.3 grams/day respectively, p=0.033) and saturated fat (-4.8 and -0.5

5

page each relating to fat and fruit & veg intake (feedback compared with recommendations, tips and messages tailored to stage of change, recipes).

information on the diet disease relationship and dietary recommendations3. No intervention control

mailed to participants

tailored group – 5.1

grams/day respectively, p=0.036). All other between group differences were not significant.

Campbell 1999,13 US

37729.3 years100%Community

Computer program (30 mins to complete) included: 15 min soap opera video, interactive infomercials with nutrition questions and tailored feedback provided, dietary advice, a specific goal for reducing fat, and low fat recipes.


Computer program: computer kiosks set up at recruitment sites.

2 1-3 months

1.1, 2.2, 4.1, 5.1, 5.2, 6.1, 6.2, 9.1, 13.1

Fat intake. FFQ. Eating behaviour survey (follow up only).Multi-choice knowledge survey.

Fat score (grams) decreased in both groups (intervention -19.7 & control -36.1). Between group difference not significant (note: baseline scores significantly higher in control & not statistically controlled for). Intervention group reported higher eating behaviour (e.g. higher low fat snack intakes) and knowledge scores (range 1-6); +0.79 vs +0.20, p <0.001.

Campbell 2004,14 US


Intervention: 4 component computer program (~25 mins to complete); video soap opera, interactive infomercials, tailored diet & psychosocial feedback, plus printed education materials, all relevant to fat, fruit & veg intake.


Computer program: computer kiosks set up at recruitment sites.

2 1-2 months

2.2, 4.1, 5.1, 5.2, 5.3, 6.1, 9.1, 13.1, 16.3

Fat, fruit & veg intake. FFQ. Multi-choice nutrition knowledge survey.

Fat and fruit/vegetable intakes moved in the expected direction for both groups, however between group differences were not significant. Knowledge of low fat foods and infant feeding increased in intervention significantly more than control.

Chapman 2009,15 UK


1.If then implementation intention group: instructed to plan to eat 5 fruit & veg portions/ day over the next week using if then statements. Examples & information on serves & health benefits were provided.

3. Education only: read the information on fruit and veg serves & health benefits only.

Print materials: participants completed the study booklets on paper,

3 1 week

If-then group – 1.1, 1.4, 4.1, 4.2, 5.1Global group – 1.1, 1.4, 4.1, 4.2,

Fruit and vegetable portions/day. Two-item screener measured usual intake

Both planning groups significantly increased intake compared with the education only group (if then group +0.5 portions/day, global group +0.31 portions/day, education only group +0.01 portions/day, p values <0.01).

6

2.Global implementation intention group: instructed to plan to eat 5 fruit & veg portions/ day over the next week, no specific instructions. Same information on serves & health benefits.

distributed during university lectures.

5.1Education group – 5.1

over the previous week.

Chapman 2012,16 UK

58021 years74%University

1. Combined implementation intention group; message encouraging increased fruit & veg intake, instructions & examples to form plans to increase intake over the next 2 months.2. Separate implementation intention group: message encouraging increased fruit & veg intake, instructions & examples to form separate plans to increase fruit & veg over the next 2 months.

3. Message only group: presented with a message encouraging them to increase fruit and vegetable intake.

Internet: participants were emailed a link to the online questionnaire/intervention

3 2 months

Combined group – 1.4, 4.1, 4.2 Separate group - 1.4, 4.1, 4.2Message group - None

Fruit and vegetable portions/day. Two-item screener measured usual intake over the previous week.

Both planning groups increased fruit intake more than the message only group (combined group +0.45portions/day, separate group +0.23 portions/day, and message only group -0.05 portions/day, p values <0.01). The separate group also increased vegetable intake compared with message only (+0.14 compared with -0.04 portions/day, p value <0.01). All other between group differences were non-significant.

De Bourdeaudhuij 2007,17 Belgium

33739.1 years68%Workplace

1. Computer tailored intervention: feedback, tailored to dietary intake and psychosocial variables e.g. stage of change + general nutrition education (e.g. benefits of low fat diet, high fat foods).2. Standard intervention: printed letter with non-tailored advice to lower fat intake + the same


1.Computer program: completed on computers at their workplace2. Print materials

3 6 months

Computer tailored intervention – 2.2, 4.1, 5.1, 8.2Standard intervention- 4.1, 5.1, 8.2

Fat intake. FFQ.

Participants in the computer tailored intervention reduced % energy from fat by 9.1%, compared with reductions of 2.3% and 1.1% for the standard intervention and no intervention control respectively. Post hoc differences between groups were all found to be significant at p<0.001.

7

general nutrition education information.

de Bruijn 2015,18 Netherlands


Two intervention groups read a positively framed health message, with normative information suggesting others either have high/low intake

Two intervention groups read a negatively framed message with normative information suggesting others either have high/low intake

Internet: messages appeared onscreen after baseline questionnaire.

4 1 week

Positive groups- 5.1, 5.6, 6.2Negative groups-5.1, 5.5, 5.6, 6.2

Fruit intake (cups/day). FFQ.

Fruit intake was significantly higher in the positively framed compared with the negatively framed health message groups (Mean±SE cups/day; 1.2 ±0.13 compared with 0.7±0.15, p=0.03). Change from baseline unclear.

de Nooijer 2006,19 Netherlands

29340 years51%Online

Participants asked to form action plans to eat an extra fruit serve/day over the next week, including planning specifically when, where and what, and how they would remind themselves to do this.


Website 2 1 week

1.4 Fruit intake (grams/day) & days eating an extra serve (follow up). FFQ.

Intervention group did not have significanlty higher grams/day of fruit intake, however 9% vs 4% reported eating an extra serve each day (b=0.13, p<0.05).

de Vet 2008,20 Netherlands

52439.3 years36%Online

Individualised feedback letters encouraging fruit intake and including match-mismatch feedback tailored to stage of change (precontemplation (PCF), contemplation (CF) or action (AF)).

Internet: letters appeared onscreen after baseline questionnaire.

3 1 week

PCF – 5.1, 13.1CF – 4.2, 9.3AF – 3.1, 4.1, 7.1, 8.2, 10.9

Fruit intake (grams/day). FFQ.

None of the feedback interventions were effective in improving fruit intake (F(2,464)=0.82, p=0.44).

Djuric 2010,21 US


1. Education group: received a 4 page educational handout including dietary recommendations, suggestions to substitute more fruit and vegetables into the diet and benefits of fruit and

2. Education + action planning group: received the same handout + an additional worksheet to complete (relating to substituting less nutritious

Print materials: intervention materials were mailed to participants

2b 3 months

Education group – 4.1, 5.1, 8.2 Education + planning group – 1.4, 4.1,

Fruit and vegetable serves/day. FFQ and 24hr recall at baseline, 24hr recall only

Change in fruit and vegetable serves was +0.4 serves/day for the education materials only group and -0.7 for the education materials plus planning group, however neither change was significant.

8

vegetables to health. foods for fruit & veg)

5.1, 8.2 at follow up.

Gans 2009,22 US

90540.4 years85.1%Primary care & Community

1. Single tailored group: tailored nutrition information, including current vs recommended intake, barriers to intake, self-efficacy/ goal setting/ social support info, recipes etc. Also received an instructional DVD with testimonials by target audience members addressing 5 motivators for healthier eating (e.g. lose weight).

2. Non-tailored group: standard nutrition brochures from national health promotion agencies, including 60 pages of information relating to lowering fat and increasing F&V.


2b 4 & 7 months

Single tailored group – 2.2, 4.1, 5.1, 5.2, 6.2, 8.2, 9.1, 12.5, 16.3Non-tailored group – 4.1, 5.1

Fruit and vegetable serves/day, assessed by 7 item screener. Fat related behaviours (score) assessed by food habits survey.

Both groups improved fruit and vegetable and fat intake at both follow ups, however between group differences were only significant for the change in fruit and veg serves at 4 months (+0.92 serves/day in the single tailored intervention group compared with +0.42 in the non tailored group, p=0.01).

Godinho 2015,23 Portugal


Intervention 1 were exposed to a risk and resources message focused on fear and persuasion. Intervention group 2 were exposed to a strategic planning message focused on action planning.

Alternative intervention control group were exposed to a message with information on functions, processes, supply & distribution of fruit & veg.

Health messages presented in a video format of ~2 minutes duration.

3 1 week

Group1- 5.1, 5.6, 15.1, 15.3Group2-1.2, 1.4, 4.1, 4.2, 5.1, 5.6, 15.1, 15.3

Fruit and vegetable portions/day. Two item screener

Fruit and vegetable intakes were not significantly different between groups at follow up.

Heimendinger 2005,24 US

2223 (5-mon),1927 (12-mon)d

NR82%Primary care

1. Tailored group received a 12-page booklet including feedback on intake vs recommendations and national statistics, information on the relationship of fruit and vegetable intake to cancer risk, suggestions

2. Untailored group received a booklet including educational material (dietary guidelines for fruit and vegetables, guide to healthy eating)


2b 5 & 12 months

Single tailored – 1.2, 2.2, 4.1, 5.1, 5.2, 6.2, 9.1Single untailored – 4.1, 5.1

Fruit & veg serves/day. 1 item measure (baseline & follow ups) & FFQ (follow

Fruit and vegetables intakes not different between groups at 5-mon or 12-mon, using the FFQ measure or single item measure.

9

to increase intake. ups only).Kellar 2005,25 UK

14621.4 years89%University

1. Action planning intervention: participants read information on fruit & veg recommended serves, motivational messages to encourage intake and instructed to form action plans for consuming the recommended serves for the next week.

2. Education only intervention: participants read the same information on fruit & veg recommendations.

Print materials: Intervention booklets completed under exam conditions

2 1 week

Action planning group – 1.4, 8.1, 8.3Education group - None

Days/ week consuming adequate fruit & veg serves. 3 item questionnaire

Action planning group reported significant increases in frequency of fruit & veg intake compared with education only; fruit intake (+0.23 days vs -0.56 days, p<0.05), veg intake (+0.43 days vs -0.14 days, p<0.01) and fruit and veg intake (+0.40 vs -0.11 days, p<0.01).

Kothe 2011,26 Australia

34920 years72.5%University

Participants were asked to write action plans for consuming breakfast in the next week after reading 1 of 3 motivational messages based on group (positively or negatively framed, or perceived behavioural control)

No intervention control (participants answered a non-related questionnaire).

Intervention completed on a website

4 4 weeks

Positive-1.4, 5.1, 5.6Negative- 1.4, 5.1, 5.5, 5.6PBC- 1.4, 8.1, 8.3

Days/week consuming breakfast. Single question measure

Between group differences not significant. However, participants in the negatively framed group (+0.9 days/week, p=0.001) & control (+0.4 days/week, p=0.002) significantly increased number of days consuming breakfast.

Kreausukon 2012,27 Thailand

11420.2 yearsNRUniversity

1. Education + psychological group: attended a 2.5 hour nutrition education lecture, provided nutrition guidelines leaflets, and participated in a psychological session targeting self-efficacy and strategic planning, including making plans to increase fruit & veg.

2. Education only group: attended the 2.5 hour nutrition education lecture & received the leaflets.

In person + print materials.

2 1 & 6 weeks

Education + psych – 1.2, 1.4, 2.2, 2.3, 5.1, 9.1, 11.2, 15.3Education only group – 2.2, 5.1, 9.1

Fruit and vegetable serves/day. 2 questions assessed usual intake over the previous week.

Both groups significantly increased intake after 6-weeks (education + psychological group +1.29 serves/day, education only +0.8serves/day, p values <0.05). The education + psychological group also had significantly higher intakes at 6 weeks (4.9 vs 4.18 serves/day, p<0.001).

Kroeze 2008a,28 Netherlan

410 (1-mon), 383 (6-

1.Interactive tailored condition: series of web pages including baseline

3. Generic condition: 2 page letter with generic

1. Computer program

3 1 & 6 months

Interactive tailored-

Fat intake. FFQ.

Change from baseline not reported. 1-month follow up: total fat

10

ds mon)43.8 years55%Workplace & Community

survey, immediate individualised feedback, nutrition education on dietary fat, motivational messages, tips to improve intake and low fat recipes. Feedback advice could be saved. 2. Print tailored condition: participants provided the same computer tailored output as interactive condition in letter form (1.5-4 pages).

nutrition information (healthy eating, low fat diet) & non-tailored advice to lower fat.

(completed on CD)2. Print materials 3. Print materials

Intervention materials were mailed.

2.2, 4.1, 5.1, 6.2, 8.2, 12.3, 13.3Print tailored- 2.2, 4.1, 5.1, 6.2, 8.2, 12.3, 13.3Generic- 4.1, 5.1, 6.2

intake significantly lower in the interactive tailored (77.4 grams/day) and print (80.5 grams/day) conditions compared with generic (88.4grams/day), p values <0.05. Saturated fat intake was also significantly lower in the interactive tailored condition (28.3 grams/day) compared with generic (31.4 grams/day), p<0.05. 6-month follow up: no between group differences.

Kroeze 2008b,29 Netherlands

571 (1-mon), 537 (6-mon)44.4 years55%Workplace & Community

Three intervention groups received tailored feedback letters with information on saturated fat, relationship to health, encouragement to make changes and feedback relevant to group: personal (P), personal-normative (PN), or personal-normative-action (PNA).

4. The generic information group received 2 pages of generic nutrition information on healthy eating and a low fat diet, with non-tailored suggestions for lowering fat intake.


4 1 & 6 months

P- 2.2, 5.1PN- 2.2, 5.1, 6.2PNA- 1.2, 2.2, 4.1, 5.1, 6.2, 8.2Generic- 4.1, 5.1, 8.2

Fat intake. FFQ.

Total fat and saturated fat intake were not significantly different between groups at 1 month or 6 month follow-ups, and change from baseline was not reported.

Lippke 2015,30 Germany


1. Stage-matched intervention: survey, info on health guidelines, & info respective to group; Non-intenders: risk awareness, outcome expectancies, goal setting & self-efficacy, Intenders: action & coping planning, Actors: action, control & coping

2. Education intervention: information on link between nutrition, physical activity & health, personalised feedback on BMI, quiz on healthy diet with individual feedback on

Computer program, completed using computer kiosks set up at the recruitment site.

2 4 weeks

Stage-matched – 1.1, 1.2, 1.4, 4.1, 5.1, 7.1, 8.2, 9.1, 9.2, 9.3, 10.9, 13.3, 15.2,

Fruit and vegetable portions/day. Single question measuring usual intake over the previous

Changes not significant (time x intervention ANOVA F(1,380)=0.55, p=0.23).

11

planning, including reviewing past behaviours and planning to overcome barriers. Completed for nutrition and physical activity.

responses, & education on dietary guidelines & food preparation.

15.3 Education – 4.1, 5.1, 7.1

month.

Luszcsynska 2007,31 Poland

20029 years66%Online

1. Self-efficacy intervention: letter with information on the importance of self-efficacy for goal achievement, feedback on self-efficacy scores compared with other participants and ways to increase self-efficacy. 1. Self-efficacy + action planning intervention: letter with above + information & instructions on action planning to achieve nutrition goals, including overcoming barriers.

3. Education intervention: participants received a letter including information on the importance of maintaining healthy nutrition and the role of social support to achieve nutrition goals.

Internet + email: questionnaires completed online & letters emailed to participants

3 6 months

Self-efficacy- 5.6, 6.2, 8.6, 15.1, 15.3Self-efficacy + action plan-1.2, 1.4, 4.2, 5.6, 6.2, 8.6, 15.1, 15.3Education-3.3, 5.1

Fruit and vegetable intake. Single item measured frequency of consuming fruit and vegetables in the past 2 weeks.

Participants in both self-efficacy intervention groups increased fruit and vegetable intake compared with the education intervention (p values <0.01), increasing consumption from once a day to twice per day, while the education intervention remained at once a day. No significant differences were found between the two self-efficacy groups.

Munoz 2007,32 US

303NR48.5%University

1. Health risks intervention: 1 page information sheet on medical risks of high soda intake, reducing intake, and completed a quiz on material. 2. Obesity risks intervention: 1 page information sheet on soda intake and weight gain/ obesity, obesity health risks, reducing intake, and completed a quiz on material.


Print materials: intervention materials were read/completed during the measurement session

3 1 month

Health risks intervention group – 4.1, 5.1, 8.2 Obesity risks intervention group – 4.1, 5.1, 5.3, 5.6, 8.2

Soda intake (grams/week). 8 item questionnaire

All three groups reduced soda intake; -636.24grams/week in the health risks intervention, -731.47grams/week in the obesity risks intervention and -241.62grams/week in the control group, however none of these reductions were significant compared with baseline or between groups.

12

Oenema 2008,33 Netherlands

181743.6 years54%Online

Website with modules on saturated fat, physical activity and smoking. Saturated fat module provided personal and normative feedback, tailored advice to reduce intake based on usual behaviour and stage of change. Content could be saved and printed.


Internet presented immediately onscreen

2 1 month

1.4, 2.2, 4.1, 6.2, 8.2

Fat intake. FFQ.

Intervention and control participants both reduced saturated fat score from baseline (-1.61 and -0.90 respectively) and the difference was significant (β=-0.76, p<0.01).

Parekh 2014,34,35 Australia


1. 1 page personalised feedback letter on their lifestyle behaviour score and individual behaviours (diet, physical activity, alcohol, smoking) including comparison to recommendations, education material for behaviours not meeting these, encouragement to adopt additional healthy behaviours, and website links for more information.

2. Control: received a 1 page personalised feedback letter regarding 5 alternative health behaviours (sun protection, vaccination, health check-ups, smoking), & additional material provided for behaviours not meeting recommendations

Print materials, mailed to participants by their recruiting general practitioner.

2b 12 months

1.1, 2.2, 5.1

Fish, spreads, salt, fruit and vegetables, milk and meat intakes dichotomised as meeting/ not meeting recommendations.

OR of meeting recommendations were significantly higher for intervention participants compared with control for fish (OR=1.26, p=0.00), spreads (OR=1.12, p=0.01), fruit and vegetables (OR=1.22, p=0.00) and milk (OR=1.15, p=0.00), but not for salt or meat intake.

Prestwich 2008,36 UK

17422.2 years76.2%University & Workplace

All participants received basic info on saturated fat, and the relevant intervention. 1. Standard implementation intention + Protection motivation message group (S-II + PMT): instructed to form plans to avoid buying high saturated fat foods in an if then

3. PMT group: read the PMT message. 4. S-II group: received the 'if then' instructions for action planning. 5. R-II group: received the reasoning instructions for

Print materials: intervention booklets distributed to participants during a un lecture or

6 1 month

S-II + PMT -1.4, 4.1, 5.1, 9.3R-II + PMT -1.2, 1.4, 4.1, 5.1, 9.3, 15.4PMT – 5.1, 9.3

Fat intake. FFQ.

% energy from saturated fat decreased in the S-II + PMT group (-2.2%1), R-II +PMT group (-0.51%) and R-II group (-0.81%). Groups receiving PMT compared to not significantly lowered saturated fat (p=0.02), as did groups making standard or reasoning implementation intentions compared to not (p=0.004 and

13

format & read PMT message (threatening the cons of high saturated fat intake + messages to increase response efficacy (e.g. pros of reducing intake)). 2. R-II + PMT group: instructed to form plans using reasoning e.g. self-talk and read the PMT message.

action planning4. Education only: received only the basic nutrition education information on saturated fat.

within their workplace, depending on recruitment site.

S-II – 1.4, 4.1R-II -1.2, 1.4, 4.1, 15.4Education only - none

p=0.04 respectively).

Raats 1999,37 UK

115NR67%Workplace

Feedback intervention: letter including % energy from fat in their diet & recommended fat intake.


Print materials: letters were mailed

2 4 & 18 weeks

2.2 Fat intake. Repeat 7-day food diaries.

Neither group significantly changed % energy from fat at either follow up. Change at 18 weeks; +0.3% for intervention and -0.1% for control.

Robb 2010,38 UK

36559.2 years59%Primary care

1. Tailored intervention: standard information leaflet (cancer risk factors & low risk behaviours) + a tailored letter (feedback on fruit, veg and alcohol intake, & physical activity vs recommendations, praise/ encouragement where recommendations were met/ not met).

2. Standard intervention group received only the standard information leaflet.3. No intervention control


3 3.5 months

Tailored intervention – 2.2, 4.1, 5.1Standard intervention – 4.1, 5.1

Fruit and vegetable serves/day. Measurement method not reported.

Both groups increased odds of meeting fruit and vegetable recommendations; standard group (OR=1.92), tailored group (OR=2.28), however only the tailored group was significant compared with control (p=0.029). Differences between the two intervention groups were not assessed.

Robinson 2014a,39 UK


1. The social norm group read a poster and flyer about vegetables including a social norm message (focusing on peer intake of vegetables).

2. The health group read a poster and flyer about the benefits of vegetables in reducing disease risk.

Print materials

2 Immediate

Social norm message - 4, 28Health message - 1

Quantity of veg eaten from a food buffet. Foods weighed pre/post

Vegetable consumption not significantly different by group. Subset analyses of high and low consumers found the social norm message was effective in low consumers (38% of meal from vegetables vs 21% in the health message group, p value <0.05).

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meal.Robinson 2014b,39 UK

7019.1 years88%University

1. Injunctive norm group read a poster and flyer about fruit & veg including an injunctive norm message focusing on peer expectations. 2. Descriptive norm group read a poster and flyer about fruit & veg including a message focusing on peer intake.

3. The health message group read a poster and flyer about the health benefits of fruit & veg.

Print materials

3 Immediate

Injunctive norm group – 6.3Descriptive norm group – 6.2Health message – 5.1

Quantity of fruit & veg eaten from a food buffet. Foods weighed pre/post meal.

Fruit and veg consumption differed by intervention group (p<0.05) and by usual intakes (high or low consumers) (p<0.05). Descriptive norm message was effective in low consumers (93% of meal from F&V versus 44% and 37% in the injunctive norm and health message groups respectively, p values <0.05).

Sacerdote 2006,40 Italy

297744.5 years50%Primary care

1. Personalised intervention: 15-min session with the GP discussing dietary guidelines using printed materials, focusing on age and sex specific recommendations, and nutrition habits below recommendations.

2. Non-personalised intervention: session with GP discussing dietary guidelines without printed materials or personalised feedback information.

1. In person + print materials.2. In person

2 6 & 12 months

Personalised group – 2.2, 5.1, 9.1Non-personalised group – 5.1, 9.1

Fruit & veg, fish, red meat & olive oil intakes. FFQ. Healthy diet score (-3 to 5) derived.

The personalised intervention compared with non-personalised participants significantly increased healthy diet score (+0.29 vs -0.04, p<0.0001), and fish serves/week (+0.4 and +0.2, p=0.01).

Smeets 2007,41 Netherlands

216047 years57%Workplace & Community

1. Tailored intervention: 5-11 page letter with feedback on fat, fruit and vegetable intake (as well as smoking status and physical activity levels) relevant to their awareness, beliefs and motivation to change behaviour, and specific dietary recommendations.

2. Non-tailored intervention: 5 page letter with generic information on fat, fruit, veg, smoking & physical activity recommendations, consequences of not meeting these + advice to improve.


2 3 months

Tailored intervention – 2.2, 4.1, 8.2Non-tailored intervention – 4.1, 5.1

Fat, fruit and vegetables intakes. FFQ.

The tailored compared with non-tailored participants decreased their saturated fat score (-2.50 versus -1.00, p<0.05) and increased fruit intake (+0.04 pieces/day versus -0.20, p<0.01). However, vegetable intake decreased in both groups (-0.48 grams/day in tailored compared with -10.40 grams/day in non-tailored, p<0.01).

Stadler 2010,42 Germany

25541.3 years100%

1. Information only group: participants studied a 4 page health education brochure

2. Information + self-regulation group: completed the same

In person + print materials: interventi

2 1 week, 1, 2, 4

Information group – 5.1, 5.6

Fruit and vegetable serves/week.

Fruit and vegetable intakes not significantly different at 1 week, 1 month or 2-month follow-up. Information + self-regulation

15

Community

encouraging a healthy diet and its benefits, and outlining fruit and vegetable recommendations, completed a quiz, and participated in group discussion of quiz answers.

information component + an additional component (set nutrition goals & learnt self-regulation techniques (e.g. mental contrasting).

ons delivered in group or individual sessions by interventionist.

& 24 months

Information + self-regulation group – 1.2, 1.4, 5.1, 5.6, 8.1, 15.6

Repeat 7-day food diaries.

group consuming significantly more serves at 4 months (29.12 vs 25.49 serves/week, p<0.02) and at 2 years (28.26 vs 23.30 serves/week, p<0.02), and significantly increased intake from baseline (+6.15 serves/week, p<0.001), compared with information only (+1.45 serves/week, p=0.22).

Vandelanotte 2005,43 Belgium

37139.1 years64.5%Community

Two modules (fat & physical activity) –baseline questions, immediate tailored feedback on behaviour vs recommendations, tips where these were not met & incorporating psychosocial variables (e.g. attitude, perceived barriers). Advice also printed to take home.


Computer program: completed during the measurement session

2b 6 months

2.2, 4.1, 5.1, 5.3, 5.6

Fat intake. FFQ

The intervention group reduced fat intake and % energy from fat (-33 grams/day and -11.5% respectively) compared with control (-7grams/day and -2.1% energy from fat), p<0.05.

Werch 2008,44 US


1. One-on-one consult: discussed current health behaviours, goals and their relation to salient image achievement.. Powerpoint slides used to reinforce key messages, & participants provided with a 1 page goal plan, including recommended goals based on screening survey.

2. Controls received a commercial brochure including information on physical fitness and an action plan and commitment form to identify habits to start, stop and keep.

1. In person + print materials2. Print materials: participants sat in a room and read the brochure

2 3 months

1.1, 2.2, 5.1, 5.6, 9.1, 9.3, 13.3, 13.5

Fat, fruit and vegetables, and carbohydrate intakes. FFQ.

Intervention and control groups were not significantly different for fruit & vegetable, carbohydrate or fat intakes.

Wiedemann 2012,45

46125.7

Intervention groups were instructed to form


Print materials

6 1 week

All intervent

Fruit & veg

All groups significantly increased fruit & veg intake,

16

Germany years81.6%University

action plans for eating an extra fruit & veg serving/day & given an example. Participants formed 1-5 plans based on their intervention group and were asked to memorise their plans.

ion groups – 1.4, 8.1

serves /day. Single item measure, usual intake in previous week.

only groups forming 4 & 5 plans significant compared with control (+0.57servings/day, p=0.04 and +0.91servings/day, p=0.03 respectively vs +0.27servings/day for controls). Difference between intervention groups not assessed.

Supplementary Table 3 Risk of bias of included studies

Study Criteria 1

Criteria 2

Criteria 3

Criteria 4

Criteria 5

Criteria 6

Criteria 7

Criteria 8

Criteria 9

Criteria 10

Rating

Armitage 20011 Y N U Y N Y Y Y Y Y NeutralArmitage 20042 Y U Y N U Y Y Y Y Y NeutralArmitage 20073 Y N Y Y Y Y Y Y Y Y NeutralArmitage 20154 Y N Y Y U Y Y Y Y Y NeutralBaker 20025 Y Y Y Y U N Y Y Y Y NeutralBlock 20046 Y N Y N N Y Y Y Y Y NeutralBrinberg 20007 Y Y U N N Y Y Y Y Y NeutralBrouwer 20158 Y N U N N Y Y Y Y Y NeutralBrug 19969 Y U Y N U Y Y Y Y Y NeutralBrug 199810 Y N Y N U Y Y Y Y Y NeutralBrug 199911 Y Y N N U Y Y Y Y Y NeutralCampbell 199412 Y Y Y Y Y Y N Y Y Y NeutralCampbell 199913 N N N Y U Y N N N Y NeutralCampbell 200414 N N Y Y N Y N Y Y Y NeutralChapman 200915 Y N Y Y N Y Y Y Y Y NeutralChapman 201216 Y N Y Y N Y Y Y Y Y NeutralDe Bourdeaudhuij 200717 Y U Y N N Y Y Y Y Y Neutral

17

de Bruijn 201518 Y Y Y Y U Y Y Y Y Y Positivede Nooijer 200619 Y Y Y Y U Y Y Y Y Y Positivede Vet 200820 Y Y Y Y U Y Y Y Y Y PositiveDjuric 201021 Y N U Y N Y Y Y Y Y NeutralGans 200922 N N Y Y Y Y Y Y Y Y NeutralGodinho 201523 Y N Y Y U Y Y Y Y Y NeutralHeimendinger 200524 Y Y Y Y U Y Y Y Y Y PositiveKellar 200525 Y N Y N Y Y Y Y Y Y NeutralKothe 201126 Y N Y N Y Y Y Y Y Y NeutralKreausukon 201227 Y N U Y N Y Y Y Y Y NeutralKroeze 2008a28 Y Y Y Y U Y Y Y Y Y PositiveKroeze 2008b29 Y Y Y Y U Y Y Y Y Y PositiveLippke 201530 Y Y Y Y Y Y Y Y Y Y PositiveLuszcsynska 200731 Y N N Y U Y Y Y Y Y NeutralMunoz 200732 Y N Y Y U Y U Y Y Y NeutralOenema 200833 Y Y Y Y Y Y Y Y Y Y PositiveParekh 201434,35 Y Y Y Y U Y Y Y Y Y PositivePrestwich 200836 Y N Y Y Y Y Y Y Y Y NeutralRaats 199937 Y N U Y U Y Y Y Y Y NeutralRobb 201038 Y U Y Y N Y U Y Y Y NeutralRobinson 2014a39 Y N Y Y N Y Y Y Y Y NeutralRobinson 2014b39 Y N Y Y N Y Y Y Y Y NeutralSacerdote 200640 Y Y Y Y Y Y Y Y Y Y PositiveSmeets 200741 Y Y Y N U Y Y Y Y Y PositiveStadler 201042 Y Y Y Y U Y Y Y Y Y PositiveVandelanotte 200543 Y Y U Y U Y Y Y Y Y NeutralWerch 200844 Y N Y Y U Y N Y Y Y NeutralWiedemann 201245 Y U Y Y Y Y Y Y Y Y Neutral

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Supplementary Table 4 Examples of behaviour change techniques used in included interventions

Behaviour change technique Example1.1 Goal setting (behaviour) Participants were set a specific goal for reducing their intake of fat based on which foods were identified as

providing the most fat in their diet from a baseline screening questionnaire 13.1.2 Problem solving Participants were provided examples of situations where consuming the recommended serves of fruit may be

challenging, and were asked to problem solve and plan strategies to overcome this 4.1.3 Goal setting (outcome) Participants were instructed to complete a worksheet including constructing goals with the outcome being

healthy eating 8.1.4 Action planning Participants were instructed to write plans of when and where they would consume an extra piece of fruit per

day, for the next two weeks 3.1.9 Commitment Participants set goals around increasing their fruit and vegetable intakes, and were then asked to make a

commitment to work towards these goals 6.2.2 Feedback on behaviour Participants were provided a comparison of reported intakes (fat, fruit and vegetables) with dietary guidelines,

and with peer intakes 9-11.2.3 Self-monitoring of behaviour Participants were provided with a range of templates to facilitate continued planning for consuming fruits and

vegetables, including nutrition calendars and action and coping planning sheets. Participants were encouraged to self-monitor their behaviour and use the templates to update plans and strategies accordingly 27.

3.1 Social support (unspecified) Participants were provided information on gathering social support and developing simple rewards for performing the target behaviour (consuming fruit) 20.

3.3 Social support (emotional) Participants were advised on the importance of seeking emotional support from friends and family if they experience difficulty in sticking to a healthy diet 31.

4.1 Instruction on how to perform the behaviour

Participants were provided information on the main sources of fat, fruit and vegetables in their diet, from self-reported intakes, with suggestions of low fat alternative foods, when and how to include more fruit and vegetables, or how to maintain intakes if recommendations were met 9-11.

4.2 Information about antecedents Participants were instructed that they would be more likely to eat more fruit if they were to plan when and where they would do this, as a pre-emptive statement before being asked to write action plans for increasing their fruit intake 3.

5.1 Information about health consequences

Participants were provided epidemiological data on population fat intakes, and morbidity and mortality from related health conditions 1.

5.2 Salience of consequences Participants were educated on the health risks of poor diet in the format of a soap opera video, in order to make the information more memorable 13.

5.3 Information about social and environmental consequences

Participants were informed of the link between excessive sugar sweetened beverage consumption and obesity, and of the social risks associated with obesity (e.g. negativity from peers) 32.

5.5 Anticipated regret Participants read health messages designed to prompt regret for not consuming breakfast by reinforcing breakfast consumption as an easy task and providing a list of negative consequences of skipping breakfast 26.

5.6 Information about emotional consequences

Participants were informed, through the use of persuasive messages, that failing to achieve the target behaviour (daily consumption of breakfast) would make them more likely to be moody and stressed 26.

19

6.1 Demonstration of the behaviour Participants watched a soap opera video focused on health risks of a poor diet, and including modelling of healthy dietary behaviours 13.

6.2 Social comparison Participants were provided a comparison of their reported fat intakes with that of age and sex matched peers.28

6.3 Information about others’ approval Participants read health messages focusing on injunctive norms, indicating that peer expectations were to consume the recommended serves/day of fruit and vegetables 39.

7.1 Prompts/cues Participants were provided with examples of cues to facilitate behaviour change e.g. increasing availability of fruit in the home by placing a filled fruit bowl in a common area 20.

8.1 Behavioural practice/rehearsal Participants first identified barriers to achieving a target behaviour (e.g. consuming fruit), and were then instructed to plan strategies to overcome these barriers as a self-regulation technique. During the face-to-face consult participants were also instructed to practice applying this technique several times in relation to different barriers 42.

8.2 Behaviour substitution Participants were provided information on the main sources of fat, fruit and vegetables in their diet, from self-reported intakes, with suggestions of low fat alternative foods 10.

8.3 Habit formation Participants were prompted to start consuming the recommended serves of fruits and vegetables and to repeat this behaviour each day, using persuasive messages and through writing action plans to achieve this 25.

8.6 Generalisation of target behaviour Participants were asked to recall a situation where they had chosen a healthy food over an unhealthy food in the past and to then plan how they would repeat this behaviour in future situations, with the healthy food choice to be fruit and vegetables 31.

9.1 Credible source Participants attended a nutrition education lecture presented by a college lecturer 27.9.2 Pros and cons Participants were instructed to set dietary goals, and to write down positive and negative consequences of

performing the behaviour 30.9.3 Comparative imagining of future outcomes

Participants completed screening questions regarding their ideal self-image, and were then advised verbally and visually in a one-on-one consultation how health risk vs health promoting behaviours, including diet, would impact them in achieving this self-image 44.

10.9 Self-reward Participants were encouraged to plan simple rewards for performing the target behaviour (fruit intake) 20.11.2 Reduce negative emotions Participants were first instructed to plan the when, where and how of consuming the recommended serves of

fruits and vegetables, and afterwards to anticipate possible barriers to carrying out these plans, as well as strategies to cope with barriers if they arose (to reduce the negative emotions around these barriers) 27.

12.2 Restructuring the social environment

Participants were advised on ways to deal with certain social situations where performing the target behaviours (e.g. low fat diet) may be difficult (e.g. eating out) 10,11.

12.3 Avoidance/reducing exposure to cues for the behaviour

Participants were advised on ways to deal with certain social situations where performing the target behaviours (e.g. low fat diet) may be difficult (e.g. eating out) 10,11.

12.5 Adding objects to the environment Participants received a fridge magnet shopping list in the mailed packet with the other intervention materials 22.13.1 Identification of self as role model Participants were provided information on the effect of role modelling for children/ partners, and encouraged to

be a role model for performing the desired behaviour (increasing fruit intake) 20.13.3 Incompatible beliefs Participants first completed screening questions including self-rating their fat intake as being above or below

dietary recommendations. Participants were then made aware of any discrepancy in their self-rated compared with actual fat intake in the tailored feedback messages that followed 10.

20

13.4 Valued self-identify Participants were first instructed to generate phrases to describe themselves as ‘doers’ of a particular desired behaviour (relevant to their healthy eating goals), then to rate where they currently were in relation to being a ‘doer’ on a scale of 1-5, and to think about what they need to do to move up on this scale 8.

13.5 Identity associated with changed behaviour

Participants completed screening questions relating to their health behaviours and ideal self-image, followed by a one-on-one consultation where participants set goals as a way to achieve this new self-image 44.

15.1 Verbal persuasion about capability Participants listened to a video message telling them that they are able to eat the recommended serves of fruits and vegetables as they would have managed this in the past, all that’s required is will and organisation, and they will feel a sense of pride if they achieve this target 23.

15.2 Mental rehearsal of successful performance

Participants were instructed to picture themselves as a ‘doer’ of the target behaviour (e.g. a fruit eater) in future contexts 8.

15.3 Focus on past success Participants were asked to recall a situation where they had consciously made the decision to consume a healthy food/drink option instead of a less healthy choice, and to recall the positive emotions associated with this, as a means to encourage repetition of the behaviour 31.

15.4 Self-talk Participants were instructed to generate phrases to describe themselves as ‘doers’ of a particular desired behaviour (relevant to their healthy eating goals) and to think about these phrases in future contexts to facilitate performance of the behaviour 8.

16.3 Vicarious consequences Participants watched a soap opera video focused on healthy dietary behaviours, the plot centred around modelling of the behaviour by the main character and the positive social and health consequences of this behaviour 14.

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