Youth peers put the “invent” into NutriBee’s online intervention

Kohlstadt et al. Nutrition Journal (2015) 14:60 DOI 10.1186/s12937-015-0031-2 RESEARCH Open Access Youth peers put the “invent” into NutriBee’s online intervention Ingrid C Kohlstadt1*, Elizabeth T Anderson Steeves1,2, Kerry Rice3, Joel Gittelsohn1, Liane M Summerfield4 and Preety Gadhoke5 Abstract Background: Early adolescents perceive peers as credible and relatable. Peers therefore have a unique conduit to engage early adolescents in positive health behaviors through nutrition learning such as that recommended by the U.S. Institute of Medicine (IOM). Purpose: We developed an online, peer leader component to an existing in-person preventive nutrition intervention called NutriBee. We reasoned that youth ages 13–18 could create intervention materials that could remain engaging, credible and relatable to younger peers ages 10–12 online. Peer leaders could potentially derive health benefits from their service-learning experience. Methods: From 2013–2014 youth could apply online to relate a personal interest to nutrition, an opportunity promoted at NutriBee pilot sites and through social media. The peer leaders with diverse backgrounds honed original ideas into tangible projects with the support of adult subject-matter experts chosen by the youth. Nutrition expertise was provided by NutriBee staff who then also converted the youth-invented projects from various media into an online curriculum. Results: 19 of 27 (70%) of selected youth from 12 states and diverse backgrounds, created an online curriculum comprising 10% of NutriBee’s 20-hour intervention. All 19 online projects modeled 1 or more of NutriBee’s 10 positive health behaviors; 8 evoked the chemosenses; 6 conveyed food texture; and 13 provided social context. Peer leaders perceived career advancement and service learning benefits. The dose, pedagogic approach, and project content align with the IOM recommendation. Conclusions: Youth created intervention materials which communicate positive health behaviors online in ways peers can adopt. In a customarily sight-sound digital platform, youth leveraged the senses of smell, taste and touch and social context important for food selection. Peer leaders derived health benefit, as indirectly assessed by IOM criteria. Keywords: Peer group, Adolescents, Attitude to health, Food preferences, Nutrition, Service-learning, Chemosensory perception, Institute of Medicine, Diffusion of Innovations Introduction In order to create impact, nutrition interventions for early adolescents must identify ways to make nutrition concepts relevant and engaging [1,2]. Incorporation of peers into intervention design and delivery is one strategy for achieving this, as peers are seen as a credible and reliable source of information [3], particularly slightly older (cross-age) peers [4]. Peers are especially important * Correspondence: 1 Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore 21401MD, USA Full list of author information is available at the end of the article for early adolescents, as developmentally this is a timeframe in which youth are most susceptible to peerinfluence [5]. Peers promote adoption of positive behaviors by helping younger peers connect learning of new material to prior experiences [6], make the abstract concrete [7] and, through collaborative learning, promote higher levels of problem solving [8]. Health interventions place increasing emphasis on narrative forms of communication such as storytelling, entertainment-education, and testimonials, approaches which lend themselves to leveraging peerinfluence [9]. © 2015 Kohlstadt et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kohlstadt et al. Nutrition Journal (2015) 14:60 Peer-led nutrition interventions have demonstrated improvements in anthropometric measures [10-12], reduced consumption of snack foods and desserts [10], increased intake of fruits and vegetables [13] and improved psychosocial factors [11,12]. Peer leaders are often used to encourage uptake of novel foods by incorporating taste tests of food items as an intervention strategy [13-17]. Nutrition eHealth interventions are beginning to incorporate peer-leaders using social marketing [18] and video [19]. Electronic platforms can greatly expand reach [20,21], thereby enabling viewers with specialized interests to find compatible peers. However peer credibility of in-person interventions isn’t necessarily retained in the transition to electronic platforms. Nutrition interventions may be at a distinct disadvantage in the etransition since food selection is heavily influenced by non-digital media such as olfaction, gustation, texture and social-cultural context [22], a challenge currently unaddressed in the education and medical research. Nutrition studies in a recent systematic review of electronic health interventions [20] were not peer-led. Furthermore, few peer-led nutrition interventions with strongly positive findings are electronic platforms, a finding which influenced the Institute of Medicine (IOM) to emphasize active learning approaches to nutrition [23]. Because of their inherent relatability and credibility, cross-age youth peers may be uniquely suited to serve as proxy for the taste, smell, texture of foods and the social milieu around which food selections are made. In theory youth-led intervention materials using electronic platforms could retain multisensory and social elements, which could be evaluated alongside behavior change constructs outlined by Diffusion of Innovations [24]. We developed a youth-led component to an existing preventive nutrition intervention called NutriBee [25], reasoning that youth ages 13–18 could creatively direct projects relating their personal interests to nutrition – projects that buttress NutriBee’s positive nutrition behaviors and retain elements online that make them credible and relatable to younger peers ages 10–12. A secondary research question is if the youth leaders could derive health benefit through their service-learning endeavors. Methods NutriBee is a middle school-aged (10–12 years of age) nutrition intervention developed at The Johns Hopkins University Center for Human Nutrition to align with the nutrition education characterized by the IOM [23]. NutriBee’s primary intervention is a 20-hour IOMaligned camp and club being disseminated nationally to early adolescents in partnership with community-based organizations and health care providers [25]. Among its engagement strategies are household reach thru childas-cha (...truncated)