Digital Versus Hybrid Interventions in Promoting Nutrition Knowledge Among Saudi Adolescent Girls

Effectiveness of Digital Versus Hybrid Interventions in Promoting Nutrition Knowledge Among Adolescent Girls: A Randomized Trial

This study primarily aims to compare the efficacy of different approaches to nutrition education intervention delivery in improving nutrition knowledge (NK) among Saudi adolescent girls. A secondary aim is to compare the effectiveness of these interventions in enhancing dietary habits and reducing Generalized Anxiety Disorder (GAD) scores.A randomized sample of 104 Saudi adolescent girls aged 16-18 years from a single high school in Makkah city enrolled in a 4-week lifestyle educational intervention for health promotion. Participants were randomly assigned to either a hybrid or a fully digital nutritional education program. Outcome measures included knowledge (NK), dietary and lifestyle habits assessed by the Healthy Plate Variety Score (HPVS), and mental health evaluated using the Generalized Anxiety Disorder (GAD) scores.

Study Overview

• Status: Completed
• Conditions: Food Habits; Body Mass Index; Generalized Anxiety Disorder (GAD); Nutrition Knowledge
• Intervention / Treatment: Behavioral: Hybrid therapy; Behavioral: Fully digital

• Study Type: Interventional
• Enrollment (Actual): 104
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Saudi Arabia
  • Mecca, Saudi Arabia
    • Al-Fatat Private School

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Healthy
• Adolescents (15-19 years old)
• Reliable internet access
• Willing to participate

Exclusion Criteria:

• Has chronic disease/s
• <15 years and >19 years
• No internet access
• Not willing to participate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hybrid intervention; Hybrid intervention that combined face-to-face educational sessions with the integration of technological advancements.	Behavioral: Hybrid therapy; Hybrid intervention that combined face-to-face educational sessions with the integration of technological advancements. They attended weekly 40-minute interactive educational sessions over the course of a month. The educational materials encompass information regarding the components of a healthy balanced diet and an active lifestyle.Throughout the intervention, participants were provided with a range of behavior change techniques to support participants in applying the educational content to improve their dietary and lifestyle habits. The employed behavior change techniques were SMART (specific, measurable, achievable, relevant, time-bound) goal setting, reviewing behavioral goals, problem-solving and environmental restructuring. The technological support for this intervention included the use of a smartphone diet tracker app called MyFitneesPal as well as communication with the interventionists via WhatsApp.
Experimental: Fully digital intervention; Received the same educational materials as the hybrid intervention group through WhatsApp twice a week over the course of one month.	Behavioral: Fully digital; Fully digital intervention, where they received the same educational materials through WhatsApp twice a week over the course of one month. The educational materials were presented through easily understandable posters, brief videos, and followed by short quizzes to reinforce the acquired knowledge. Additionally, the digital intervention incorporated the same behavior change strategies that were utilized in the hybrid group. Participants were also introduced to MyFittnessPal application in order to help them track their dietary habits and monitor their progress since it is considered a tool for self-monitoring and promoting healthy dietary behaviors throughout the intervention period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nutrition knowledge	Nutritional Knowledge was assessed using a validated dietary questionnaire, distributed in Arabic (24). The questionnaire comprised 10 items, with a maximum score of 10 points. Each correct response was awarded 1 point, while incorrect answers or uncertain responses received a score of zero. The final score was derived by summing the total points. To classify NK levels, modified Bloom's cut-off points were employed: a score of 80-100% (8-10 points) indicated good NK, 50-79% (5-7.9 points) represented moderate knowledge, and scores below 50% (<5 points) denoted low knowledge. For analytical purposes, these categories were dichotomized into satisfactory NK (>80% correct) and unsatisfactory NK (<80% correct) (7,25).	From enrollment to the end of treatment at 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Generalized Anxiety Disorder Scores (GAD)	Anxiety levels were measured using the GAD-7. This is a 7-item validated questionnaire (28), which is widely used to screen for and quantify the severity of GAD. The Arabic version of this tool has been adopted by the Saudi Arabian Ministry of Health for initial anxiety screening. Each item is rated on a 4-point Likert scale, ranging from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 21. Higher scores reflect greater anxiety levels. Anxiety was defined using a cutoff score of 10 or above, which differentiated between minimal to mild anxiety and moderate to severe anxiety (28).	From enrollment to the end of treatment at 4 weeks
Dietary habits	Dietary habits were evaluated using a questionnaire adapted from research on food consumption frequencies in Qatar, which share similar characteristics with Saudi Arabia. The questionnaire assessed the frequency of consumption of various food groups, including vegetables, fruits, carbohydrates (e.g., bread, rice, pasta), proteins (e.g., chicken, beef, fish), and dairy products (e.g. yoghurt and cheese). Participants responded to questions such as, "How often do you consume fresh fruits/green leafy vegetables/fish? To evaluate dietary variety, the study employed the Healthy Plate Variety Score, calculated using a modified methodology based on Jones et al. (2015). This approach involved dichotomizing food intake from the five main groups into two categories (daily intake vs. non-daily). Foods consumed daily received a score of 1, while those not consumed daily received a score of 0 with a potential maximum score of 5.0.	From enrollment to the end of treatment at 4 weeks
Anthropometric measurements (Body mass index)	Body measurements were obtained using standardized equipment following established operating procedures. Trained senior dietitians objectively assessed the height and weight of adolescents using a mechanical combined scale and a stadiometer (Detecto). Prior to measurement, a technician ensured that the equipment was properly calibrated. Height was recorded to the nearest 0.1 cm while participants were barefoot and dressed in minimal clothing. Weight was measured and documented to the nearest 0.1 kg. The Body Mass Index (BMI) was calculated by dividing the weight in kilograms by the square of the height in meters. Weight status was classified according to the criteria set by the World Health Organization (WHO): underweight was defined as a BMI of less than 18.5 kg/m², normal weight ranged from 18.5 to 24.9 kg/m², overweight was categorized as a BMI between 25.0 and 29.9 kg/m², and obesity was indicated by a BMI of 30.0 kg/m² or higher.	From enrollment to the end of treatment at 4 weeks

Collaborators and Investigators

• Sponsor: Umm Al-Qura University
• Investigators: Principal Investigator: Mai A Ghabashi, PhD, Umm Al-Qura University

Publications and helpful links

General Publications

• Das JK, Salam RA, Thornburg KL, Prentice AM, Campisi S, Lassi ZS, Koletzko B, Bhutta ZA. Nutrition in adolescents: physiology, metabolism, and nutritional needs. Ann N Y Acad Sci. 2017 Apr;1393(1):21-33. doi: 10.1111/nyas.13330.
• Ashton LM, Sharkey T, Whatnall MC, Williams RL, Bezzina A, Aguiar EJ, Collins CE, Hutchesson MJ. Effectiveness of Interventions and Behaviour Change Techniques for Improving Dietary Intake in Young Adults: A Systematic Review and Meta-Analysis of RCTs. Nutrients. 2019 Apr 11;11(4):825. doi: 10.3390/nu11040825.
• Hargreaves D, Mates E, Menon P, Alderman H, Devakumar D, Fawzi W, Greenfield G, Hammoudeh W, He S, Lahiri A, Liu Z, Nguyen PH, Sethi V, Wang H, Neufeld LM, Patton GC. Strategies and interventions for healthy adolescent growth, nutrition, and development. Lancet. 2022 Jan 8;399(10320):198-210. doi: 10.1016/S0140-6736(21)01593-2. Epub 2021 Nov 29.
• Charles Shapu R, Ismail S, Ahmad N, Lim PY, Abubakar Njodi I. Systematic Review: Effect of Health Education Intervention on Improving Knowledge, Attitudes and Practices of Adolescents on Malnutrition. Nutrients. 2020 Aug 13;12(8):2426. doi: 10.3390/nu12082426.
• Bany-Yasin H, Elmor AA, Ebrahim BK, Ahmed AAM, Alarachi MR, Abedalqader L, Amer R, Alyousef AMS, Alhajeh YF, Alyoussef A, Eid HAMA, Elsayed MM, Desouky EDE, Salem HK, Salem MR. Exploration of the nutrition knowledge among general population: multi-national study in Arab countries. BMC Public Health. 2023 Jun 19;23(1):1178. doi: 10.1186/s12889-023-15791-9.
• Saha S, Okafor H, Biediger-Friedman L, Behnke A. Association between diet and symptoms of anxiety and depression in college students: A systematic review. J Am Coll Health. 2023 May-Jun;71(4):1270-1280. doi: 10.1080/07448481.2021.1926267. Epub 2021 Jun 4.
• Lwin EZ, Watthanakulpanich D, Phetrak A, Soonthornworasiri N, Prangthip P. Factors influencing secondary school students' nutrition, mindfulness, and academic performance in Nan Province, Thailand. PLoS One. 2025 Jan 14;20(1):e0308882. doi: 10.1371/journal.pone.0308882. eCollection 2025.
• Hamulka J, Czarniecka-Skubina E, Gutkowska K, Drywien ME, Jeruszka-Bielak M. Nutrition-Related Knowledge, Diet Quality, Lifestyle, and Body Composition of 7-12-Years-Old Polish Students: Study Protocol of National Educational Project Junior-Edu-Zywienie (JEZ). Nutrients. 2023 Dec 19;16(1):4. doi: 10.3390/nu16010004.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2023
• Primary Completion (Actual): December 31, 2023
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: February 9, 2025
• First Submitted That Met QC Criteria: February 17, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 17, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: Adolescents; Anxiety; Diet; Educational intervention; Digital; Saudi Arabia; Nutritional knowledge; Hybrid intervention
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders
• Other Study ID Numbers: HAPO-02-K-012-2023-10-1787

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No