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BACKGROUND In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site’s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. OBJECTIVE This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. METHODS Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. RESULTS A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. CONCLUSIONS This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19–specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution.

Background In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site’s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19–specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution.

Behavior change, albeit simple in concept, is actually a myriad of complex processes designed to address numerous constructs. It is because of this complexity that practitioners should be careful t...

Background The impact of integrating video into health education delivery has been extensively investigated; however, the effect of integrating video on a learner’s subsequent performance in an online educational setting is rarely reported. Results of the relationship between the learner’s online video viewing and subsequent progression toward health behavior change in a self-directed online educational session are lacking. Objective This study aimed to determine the relationship between viewing a Health eKitchen online video and key engagement performance indicators associated with online nutrition education for women, infants, and children (WIC). Methods This study involved a retrospective cohort of users grouped on the basis of whether Health eKitchen exposure occurred before or after completing a nutrition education lesson. A two-sample test for equality of proportions was performed to test the difference in the likelihood of progression between the groups overall and when stratified by lesson type, which was defined by whether the lesson focused on food preparation. Welch two-sample t tests were performed to test the difference in average link depth and duration of use between groups overall and stratified by lesson type. Logistic regression was conducted to validate the impact of video viewing prior to lesson completion while controlling for lesson type and factors known to be associated with WIC key performance indicators. Results A greater stage of change progression was observed for both food preparation (χ2=12.6, P Conclusions User access to a Health eKitchen video prior to completion of an online educational session had a significant impact on achieving lesson goals, regardless of the food preparation focus. This observation suggests the potential benefit of providing an application-oriented video at the onset of online nutrition education lessons.

BACKGROUND The impact of integrating video into health education delivery has been extensively investigated; however, the effect of integrating video on a learner’s subsequent performance in an online educational setting is rarely reported. Results of the relationship between the learner’s online video viewing and subsequent progression toward health behavior change in a self-directed online educational session are lacking. OBJECTIVE This study aimed to determine the relationship between viewing a Health eKitchen online video and key engagement performance indicators associated with online nutrition education for women, infants, and children (WIC). METHODS This study involved a retrospective cohort of users grouped on the basis of whether Health eKitchen exposure occurred before or after completing a nutrition education lesson. A two-sample test for equality of proportions was performed to test the difference in the likelihood of progression between the groups overall and when stratified by lesson type, which was defined by whether the lesson focused on food preparation. Welch two-sample t tests were performed to test the difference in average link depth and duration of use between groups overall and stratified by lesson type. Logistic regression was conducted to validate the impact of video viewing prior to lesson completion while controlling for lesson type and factors known to be associated with WIC key performance indicators. RESULTS A greater stage of change progression was observed for both food preparation (χ2=12.6, P CONCLUSIONS User access to a Health eKitchen video prior to completion of an online educational session had a significant impact on achieving lesson goals, regardless of the food preparation focus. This observation suggests the potential benefit of providing an application-oriented video at the onset of online nutrition education lessons.

Background WIC provides nutrition education and support during critical periods of growth and development to participants. However, little has been reported on WIC participants’ existing awareness of food sustainability issues. Objective The purpose of this study was to determine the effect of attitudes, perceptions and behaviors around food sustainability on the adoption of three new behaviors; willingness to increase intake of fresh fruits and vegetables, increase breastfeeding initiation and duration and reduce food waste to maximize food dollar. Study Design, Settings, and Participants A cross-sectional design included three online surveys. WIC participants completed surveys at the end of lessons delivered through wichealth.org, a well established parent-child feeding behavior intervention used by WIC agencies in 32 states. Participants from seven wichealth.org partner states self-selected completion of the breastfeeding (n = 612), or two food waste (n = 1,178 and n = 773) surveys. Measurable Outcome/Analysis Surveys were comprised of binary or nominal and Likert scale items. Data were analyzed using descriptive statistical analysis. Results Breastfeeding survey respondents were twice as likely to agree sustainability knowledge would impact breastfeeding choices. More than half (53%) of food waste survey respondents believed food waste is a problem for most households, with big portion sizes the most often answered (30%) reason for food waste. Respondents estimated 80% of food waste is thrown away, with leftovers more than twice as likely than fruits and vegetables to be thrown away. Only 12% correctly estimated the monetary value of food waste, while 80% underestimated the national average. Finally, 71% of respondents were interested in decreasing food waste. Conclusion Findings show a need for providing online knowledge, tools and skills for food sustainability, which may influence WIC participant behaviors surrounding healthy food supplies. Practical applications include incorporating food sustainability concepts and behavior into WIC nutrition education, especially participants using wichealth.org, as a well as further research.

This study examined the current technology use of clients in the western Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) region and the preferences these current clients have for using new technologies to interact with WIC.Cross-sectional convenience sample for online survey of WIC clients over 2 months in 2011.A weighted sample of 8,144 participants showed that the majority of WIC clients have access to the Internet using a computer or mobile phone. E-mail, texting, and Facebook were technologies most often used for communication. Significant differences (P.05) existed between age groups and Facebook use, education level and technology use for education delivery, and education level and use of video chat.Technologies should be considered for addressing WIC clients' needs, including use of text messaging and smartphone apps for appointments, education, and other WIC services; online scheduling and nutrition education; and a stronger Facebook presence for connecting with WIC clients and breastfeeding support.

Health-assessment tools assist practitioners in developing interventions to promote health. An increasing number of online health assessments have evolved recently, creating a need to evaluate for usefulness and effectiveness. This study reviewed 42 online health assessments based on recommendations developed by the Scientific Panel on Interactive Communication and Health. Four types of health assessments were reviewed, with Health Status/Positive Well-Being types, as a whole, demonstrating the highest scores. At least 75% of all sites received maximum scores for items related to background of developers and sponsors, purpose of site, and site design. Fewer than 1 of 5 sites received a maximum score for content issues, confidentiality, and evaluation results and effectiveness. Particularly poor scores were received for the evaluation criteria. Developers of online health assessments need to modify sites to incorporate evaluation results and effectiveness. Practitioners need to be cautious in using sites with no reported evaluation efforts.

Background: Online health education has expanded its reach due to cost-effective implementation and demonstrated effectiveness. However, a limitation exists with the evaluation of online health education implementations and how the impact of the system is attenuated by the extent to which a user engages with it. Moreover, the current online health education research does not consider how this engagement has been affected by the transition from fixed to mobile user access over the last decade. Objective: This paper focuses on comparing the impact mobile versus fixed devices have on user engagement key performance indicators (KPI) associated with the wichealth website (.org), an Internet-based parent-child feeding intervention offered to clients associated with the US Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Data were collected from 612,201 nutrition education lessons completed by 305,735 unique WIC participants in 21 states over a 1-year period. Data consisted of system-collected measures, profile items, and items from an exit survey administered at the conclusion of each lesson. User engagement was defined based on 3 KPIs associated with usage of the wichealth website: number of link views, link view time, and progression in stage of readiness to change. Independent samples t tests were used to compare KPIs between fixed only and mobile only device users and paired samples t tests were used to compare KPIs within users who completed at least one lesson each on both a fixed and mobile device. A logistic regression was performed to estimate the odds of KPI performance thresholds in the independent samples study group given access device type while controlling for confounding of user characteristics associated with these KPIs. Results: Analysis of 8 user characteristics (lessons completed, race, ethnicity, language, state of residence, pregnancy status, beginning stage of change, and preferred nutrition education method) were significantly (P

The purpose of this project was to compare the impact of Internet nutrition education to traditional nutrition education on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant fruit and vegetable consumption. Interventions were delivered at 15 WIC clinics after normal WIC clinic operations or delivered online. A total of 692 and 872 participants from eight WIC agencies self-enrolled into two phases. A quasi-experimental design using an interrupted time series to determine the impact of two methods of nutrition education and follow-up nutrition counseling was used. Data were collected online and at Michigan WIC clinics during 2005-2007 at 3-month intervals during a 9-month period (per phase). Two Internet nutrition education modules were compared to WIC traditional nutrition education, which included either group classes or a self-guided nutrition education information mall. All interventions were based on the same program learning objectives. Optional motivational negotiation counseling followed 3 months post-intervention. Stage of change progression, belief in ability to change, and fruit and vegetable consumption were measured at baseline, immediately after the intervention, and 3 and 6 months post-intervention. Significance (P0.05) was analyzed using independent samples t tests, χ(2) distribution, and sample tests for differences in binomial proportions. The Internet group experienced substantial positive differences in stage of change progression, perception that the intervention was helpful and easy to use, and fruit and vegetable consumption. Traditional nutrition education required follow-up counseling to achieve fruit and vegetable consumption levels similar to the Internet nutrition education group. Based on these findings, this study supports Internet nutrition education as a viable alternative to traditional nutrition education for increasing fruit and vegetable consumption in some WIC clients.

(1991). Defining Spiritual Health: A Review of the Literature. Journal of Health Education: Vol. 22, No. 5, pp. 287-290.

Objective To determine the usefulness and impact of wichealth.org on stage of change associated with 8 WIC client nutrition issues. Design Cross-sectional design. Data were collected through an online survey and via Web pages visited by clients for each module. Setting wichealth.org intervention and data collection are Internet-based. Participants 39 541 WIC participants from 7 states completed a module and online survey. Subjects were likely between the ages of 18 and 34, residing in Michigan, Illinois, or Indiana, and accessing the Internet from home. Interventions Intervention included 5 online modules focusing on parent-child feeding behaviors. Variables Measured Impact variables included stage of change movement, user belief in ability to engage in behavior, and perception of site usefulness. Analysis Data were reported using frequency, ANOVA (analysis of variance) (P Results Movement in stage was greatest for the “picky eater” (PE) module. Contemplation as the beginning stage had the greatest stage movement. Participants responded well to all measures of site usefulness. User belief in ability to engage in behavior was associated with 7 of the 8 modules. Implications for Research and Practice wichealth.org is a highly popular and viable method for impacting movement in stage of change with a number of parent-child feeding issues.

OBJECTIVE To provide a review of weight management components as a means for developing suggested guidelines for online program development or selection. METHODS Forty-two published studies associated with Internet programs were reviewed. RESULTS Studies included online weight management components: tailored feedback, social support, self-monitoring, and interactive components. Five key principles associated with Internet-based weight management programming are presented: (1) recreate the human experience, (2) personalize to the individual, (3) create a dynamic experience, (4) provide a supportive environment, and (5) build upon sound theory. CONCLUSIONS Key principles can guide in the development or selection of online weight management programs.