Nutrition and Physical Activity: Worksite Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends worksite digital health and telephone interventions focused on improving healthy eating and physical activity among working adults interested in improving these behaviors.

Systematic review evidence shows these interventions demonstrated meaningful increases in time spent in physical activity, increases in fruit and vegetable intake, and decreases in fat intake.

The CPSTF has related findings for the following:

The full CPSTF Finding and Rationale Statement and supporting documents for Nutrition and Physical Activity: Worksite Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions aim to increase healthy eating and physical activity using websites, mobile apps, text messages, emails, or one-on-one telephone calls. Interventions include educational information plus one or more of the following:

  • Coaching or counseling from trained professionals
  • Self-monitoring to record healthy eating, physical activity or weight
  • Goal setting
  • Computer-generated feedback that provides tailored information

Interventions also may include one or more of the following:

  • Social support from peers through social media, internet forums, or discussion groups
  • Motivational strategies that include incentives, rewards, prompts, and gaming techniques

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of eight studies with 11 study arms (search period: January 2009-June 2020).

Study Characteristics

  • Included studies were conducted in the United States (6 studies), Denmark (1 study), and Germany (1 study). Only one study reported on population density, which was urban.
  • All included studies recruited participants from large worksites (>300 employees). Participants included social and healthcare workers in a nursing home (1 study), shift workers with physically demanding work (1 study), government workers (1 study), management and administrative personnel (3 studies), and a mix of management, clerical, and labor workers (2 studies).
  • Across all eight studies, participants had a mean age of 47.4 years. Studies reported higher proportions of females than males (on average, 70% were female). Intervention duration ranged from one month to 12 months, with a median duration of six months.
  • The six U.S. studies reported racial and ethnic distributions. Studies included participants self-identified as White (median 57.3%; 6 studies), Black or African American (median 7.1%; 5 studies), Hispanic or Latino (median 4.0%; 5 studies), Asian (median: 4.0%; 4 studies), or other race/ethnicity (median 3.6%; 5 studies).
  • Seven studies provided enough information to assess participants’ income. Participants represented populations considered to be lower income (1 study), higher income (3 studies), or a combination of higher, middle, and lower income (3 studies).

Summary of Results

Physical Activity

  • Physical activity increased by a median of 38.5 minutes per week (2 studies with 4 study arms). Additional measures of physical activity demonstrated favorable findings (4 studies with 5 arms).

Dietary Behaviors

  • Fruit and vegetable intake increased by a median of 0.44 servings per day (2 studies with 4 study arms).
  • Fat intake decreased (3 studies with 4 study arms).

Weight-related

  • Body mass index results were mixed (4 studies with 5 arms); and weight decreased (2 studies with 2 arms).

Clinical

  • Clinical outcomes including systolic blood pressure, diastolic blood pressure, total cholesterol, high density lipoprotein, and glucose did not change (2 studies with 2 arms).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

The CPSTF finding should be applicable to all working adults who are interested in improving these behaviors regardless of sex, income level, race, or ethnicity.

Evidence Gaps

  • How effective are interventions in worksites that are small (less than 100 employees) or medium sized (100 to less than 300 employees)?
  • Are these interventions effective in rural areas?
  • What are the long-term effects of digital health interventions among working adults?
  • What is the effect of interventions that last longer than 12 months?
  • What are the effects of incorporating wearable devices or trackers in the intervention?
  • What are the effects of adding social media to the intervention?
  • What is the ideal level of intensity for this type of intervention?

Implementation Considerations and Resources

It is important to note that these interventions were conducted among working adults; therefore, not all populations would benefit to the same degree. Additionally, the CPSTF does not endorse any specific digital health intervention.

  • Interventions incorporating digital health are a convenient way to reach individuals in worksites. They have the potential for broad dissemination and scalability (Carter et al., 2013; Roess, 2017; Svetkey et al., 2015).
  • Interventions aiming to help adults lose weight may require greater intensity, longer durations, or both. Implementers might consider their population of interest to determine reasonable expectations.
  • Populations may respond differently to varying levels of intensity. For example, younger adults may be more comfortable tracking their daily behaviors on mobile devices than older adults would be.
  • Programs may want to consider participants’ electronic literacy. The CPSTF suggests worksites consider tailoring interventions to the electronic and literacy levels of their employees.
  • CPSTF suggests implementers make these programs accessible to workers of all types of jobs and all races/ethnicities.
  • The digital divide needs to be considered when using technology other than telephones to implement programs. Key issues include participants’ access to affordable internet networks or mobile devices and digital readiness. Worksite programs may be able to provide employees with resources and opportunities that address this concern.
  • Programs may want to consider the built environment. It is important for participants to have access to healthier foods and safe places where they can be physically active.
  • CPSTF suggests implementers incorporate behavior change theories into program designs.
  • Data security and privacy issues need to be considered when individuals enter personal information electronically.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.