Transtheoretical model-based nutritional interventions in adolescents: a systematic review
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Abstract
Background: Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. Purpose: This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake. Methods: This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results: The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. Conclusion: The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change’ construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.
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Seven high-quality and one moderate-quality reviews (including 192 unique studies) reported promising effects of multi-component interventions on healthy eating behaviour.
“There were promising effects of multi-component interventions on healthy eating behaviour reported in seven high-quality [30, 32, 35–38, 45] and one moderate-quality reviews [42] (including 192 unique studies) [30, 32, 35–38, 42, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results (page not provided) say this review included 17 articles covering 14 interventions, not eight reviews covering 192 unique studies. Its Methodological quality section rates interventions—not reviews—as three strong, six moderate and five weak. The Main outcomes section does report some improvements in eating behaviour, but not the claimed review-level finding. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe intervention duration ranged from 15 min to 10 years, and follow-up assessments ranged from immediately to four years after the intervention.
“The intervention duration ranged from 15 min to 10 years [30, 36–38, 42, 45] and time of the follow up assessments ranged from immediately to four years after the intervention [30, 32, 36, 37, 42].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results section ('Study design characteristics'; page unavailable) says study duration, including pre- and post-test measurements, ranged from one month to three years—not 15 minutes to 10 years. The Results table ('Intervention strategies and measured variables'; page unavailable) lists follow-up assessments as late as three years in an example, but the paper does not report the claimed four-year endpoint. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAll the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs.
“All the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs [30, 35–38, 42, 43, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results table lists studies from the United States and Brazil, so this review includes studies from both a high-income country and a lower- or middle-income country. This paper reviews adolescent nutritional interventions; it does not establish the sentence’s totals of eight reviews and five LMICs across reviews. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThese reviews mainly focused on interventions in HICs, with only 11 primary studies from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia).
“These reviews mainly focused on interventions in HICs - only 11 primary studies were from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia) [30, 35–38, 42, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results report 14 interventions, and Table 1 lists studies from Iran and the United States, supporting the broad point that the review includes both LMIC and HIC settings. This paper does not establish the citing sentence’s aggregate count of 11 LMIC primary studies across multiple reviews or its five-country list; Table 1 also lists interventions in Brazil. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe primary outcomes for the reviews reporting promising effects were intake of FV, processed snacks, SSB, fat, protein, fibre and vitamins, frequency of regular meals, recommended calorie intake, healthy eating knowledge, and staying in school for having healthy lunch.
“The primary outcomes for these reviews were intake of FV [30, 32, 36–38, 42, 45], processed snacks [30, 36–38, 45], SSB [30, 35, 37], fat [37, 42], protein, fibre and vitamins [37], frequency of regular meals [30, 37, 38], recommended calorie intake [37, 42], healthy eating knowledge [30, 36], and staying in school for having healthy lunch [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results (Main outcomes; no page number in our copy) report fruit-and-vegetable and fat intake outcomes. The Other outcomes subsection reports reduced daily calorie intake, but not whether participants met a recommended calorie intake. The review does not report processed-snack or sugar-sweetened-beverage intake, protein, fibre or vitamin intake, or regular-meal frequency as outcomes of the reviewed interventions. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The contents of healthy eating education components involved lessons on healthy eating, food labelling, healthy cooking, consequences of SSB intake, nutrition, food safety farmers' visits on healthy food cultivation, menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting.
“The contents involved lessons on healthy eating [32, 37, 38, 42, 45], food labelling, healthy cooking [30, 36], consequences of SSB intake [35], nutrition, food safety farmers’ visits on healthy food cultivation [36], menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results sections on nutritional topics and intervention strategies (no page supplied) describe healthy-eating education and goal-setting worksheets. They do not describe food tasting or using healthy food as rewards, which are among the components attributed to this source by the final [38] citation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe healthy eating education components at the individual level included lectures, quizzes and games, media shows, plays, electronic messages, rewards, peer-leading activities and training for teachers.
“The healthy eating education components at the individual level, included lectures [30, 32, 36, 38, 42, 45], quizzes and games [30, 36, 38], media shows [37], plays, electronic messages, rewards, peer-leading activities and training for teachers [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results sections describe classroom lessons, a card game, videos, SMS messages, tailored electronic feedback, and a peer-led healthy-eating program. The passages do not describe plays, rewards, or training for teachers as intervention components. They also do not classify the listed activities collectively as individual-level components. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe outcomes in the studies were measured by FFQ, 24 h dietary recalls, food diary, KAP survey, cognitive and attitudinal assessments, FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale, and 7-day recall, or 5-day food recall.
“The outcomes were measured by FFQ [32, 35–38, 42, 45], 24 h dietary recalls [32, 35–38, 45], food diary [38, 42], knowledge attitude practice (KAP) survey [32, 45], cognitive and attitudinal assessments [38], FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale [38], and 7-day recall [45], or 5-day food recall [42].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results section, under “Intervention strategies and measured variables” (page unavailable), identifies food frequency questionnaires and food diaries as assessment methods in the reviewed studies. It does not substantiate the sentence’s more specific list, including 24-hour dietary recalls, KAP surveys, school-lunch and snack measures, or 5- and 7-day recalls. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe contents of family involvement components involved information on healthy eating knowledge, healthy cooking, feeding healthy foods to children at home, nutritional guidelines, coupons to purchase healthy foods, offering FV and free healthy foods.
“The contents involved information on healthy eating knowledge [30, 32, 35, 38, 42, 45], healthy cooking, feeding healthy foods to children at home [37], nutritional guidelines [38], coupons to purchase healthy foods [37], offering FV and free healthy foods [45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
The Results (Intervention strategies and measured variables; Nutritional topic covered in the intervention, page unavailable) describe healthy-eating education, fruit-and-vegetable promotion, cooking skills, and letters to families. They do not establish that the family-directed components included cooking or feeding children healthy foods at home, nutritional guidelines, coupons, or free or offered foods. The review describes promoting fruit-and-vegetable consumption, not providing produce. (LLM, conf=0.79)
Experimental — accuracy not yet measuredThese reviews mostly included studies based in HICs; eight reviews among these 14 included primary studies based in five LMICs.
“These reviews mostly included studies based in HICs. Eight reviews among these 14 included primary studies based in five LMICs [30, 35–38, 42, 43, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [42]
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- Authors
- Nakabayashi, J., Melo, G. R.-I., & Toral, N.
- Affiliations
- Universidade de Brasília (BR)
- Corresponding author
- Nakabayashi, Jennifer
- Venue
- BMC Public Health
- Published
- 2020-10-14
- Volume
- 20
- Issue
- 1
- Pages
- 1543-1543
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC7557045
- OpenAlex
- W3093396767
- Cited by
- 58
- References
- 49
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 12 · 2023: 7 · 2022: 9 · 2021: 6
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- transtheoretical model, dietary intervention, adolescents, dietary intake, fruit and vegetable intake, low-fat diet, cooking skills, stages of change, readiness to change, behavior change, school-based intervention, digital health technologies
- MeSH terms
- Transtheoretical Model, Adolescent, Diet, Fruit, Health Education, Humans, Nutrition Disorders, Schools, Vegetables, Randomized Controlled Trials as Topic
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